166 coLia 



with the idea of causing changes in the neighbourhood of the invaginated 

 part ; but such treatment presents Httle chance of success. The same is 

 true of the administration of large doses of ohve oil, either in the form of 

 draught or of enema. 



Siebert attempted reduction by generating CO2 from soda bicarbo- 

 nate dissolved in water and diluted HCl, injected successively per 

 rectum. In time faeces and CO2 escaped, and the patient recovered. 

 Siebert claims to have cured by this method a cow with invagination of 

 five days' duration ; but the effect of his treatment may be doubted, as 

 afterw^ards a portion of bow^el was found in the cow's dung. 



When diagnosis is certain, the only treatment that can be recom- 

 mended consists in performing laparotomy followed by enterotomy. 

 One cannot, however, operate in all cases, nor do all cases offer the same 

 chances of success. If the invagination is situated in the first portion 

 of the small intestine, and is hidden beneath the circle of the hypo- 

 chondrium, intervention is out of the question, but if it has been 

 detected by rectal exploration in the last portion of the intestine, 

 operation may prove successful. Only in cases of the latter description 

 should it be attempted. 



Laparotomy is performed in the right flank according to the usual 

 method (see Moller and Dollar's "Regional Surgery," p. 313). After 

 opening the peritoneal cavity, the invaginated loop of intestine must be 

 sought. It is not always easy to discover amongst the mass of intestines 

 present, but can be recognised by its hardness and by the congestion 

 of neighbouring parts. After withdrawing it through the abdominal 

 opening, the oj^erator may then proceed by one of several methods. 



(1.) Some authors recommend grasping the two ends, drawing them 

 apart, and thus reducing the invagination. The actual manoeuvre is 

 not difficult, but even when unattended by accident or tearing of the in- 

 testine it is by no means always followed by recovery. Although the 

 intestine may not appear gangrenous externally, necrosis often occurs 

 eventually. 



This method should only be practised during the first twenty-four 

 hours after the appearance of colic, and even then one must always bear 

 in mind the possible consequences just mentioned, and the chances of 

 rapidly fatal septic peritonitis. 



(2.) The second method consists in removing the invaginated portion 

 of intestine. It is best to apply bichromatised catgut or silk ligatures 

 to all the arteries which pass from the mesentery into the loop to be re- 

 moved ; after which the loop itself may be simply divided an inch or two 

 above and below the invagination, in order to be quite certain that one is 

 operating on healthy tissue, the divided ends being held meanwhile by 

 an assistant. The intestine is afterwards sutured with a fine needle and 



