592 TREATMENT OF TWIST OF THE COLON. 



It is clear that all torsions of the colon cannot be treated by one 

 and the same method ; differences in displacement will render modi- 

 fication necessary ; but when attention has been directed to the 

 point , experience will give valuable indications for procedure. Puncture 

 of the over-distended colon might possibly assist reduction (see 

 " Puncture of the Bowel "). Jelkmann was compelled to puncture 

 the caecum five times in thirteen cases, after which retroversion 

 succeeded ; the use of the trocar caused no bad results. 



Before attempting manipulation, Gultmann evacuates the gas 

 by puncture. Imminger and others recommend puncture and claim 

 to have seen reduction of the twist in consequence. Whether puncture 

 is always necessary can only be settled by more extended observation. 

 It is desirable that reduction should be attempted oftener than at 

 present ; those who have tried it speak of the method in favourable 

 terms. 



Moller describes the following case : — ■ 



I was called to see a heavy cart-horse which had been suffering from 

 colic for twenty hours. There was moderate but continued restlessness ; 

 the animal lay down frequently, but soon rose again, moved about in 

 various directions, and showed all the symptoms of obstruction of the 

 bowel. The pulse was sixty-five per minute, small and weak, the mucous 

 membranes dirty red, respirations thirty and shallow, the flank moderately 

 distended with gas, peristalsis occasionally slightly audible at the right 

 side, and general sweating. Defalcation had been in abeyance for twenty 

 hours, only three hard portions of dung having been passed, the appetite 

 had decreased during the same period, and drink was only taken in small 

 quantities. Examination per anum discovered the pelvic flexure of the 

 colon greatly distended with gas, which caused it to be pressed towards 

 the posterior wall of the pelvis. On the outer surface of the colon a tense 

 cord could be felt which passed from above downwards and inwards, from 

 behind upwards and outwards. A similar cord passing in the same direction 

 could be detected on the inner surface of the colon ; the urinary bladder 

 was only partially filled. 



The hand introduced into the rectum, was laid in the above described 

 manner against the outer cord, and after several attempts it was found 

 possible by very considerable exertion, to move the bands of the colon 

 towards the middle line of the abdomen. Active peristalsis and passage 

 of gas at once followed, after which firm excreta were passed. The rest- 

 lessness decreased, and after a short time entirely disappeared, whilst the 

 pulse recovered its normal condition, and the mucous membrane lost its 

 redness. In an hour, pain was entirely gone. 



Other forms of displacement of the bowel in horses have not yet 

 been surgically treated, if we except Meschkow's case, in which the 

 rectum was strangulated by coils of small intestine. Meschkow 

 pei formed laparotomy, reduced the strangulation, and the horse 

 recovered. 



