Fcecal A ecu in illation 



329 



guide to the bowel when Amussat's post-peritoneal operation is being 

 performed. 



Showing sites of faecal 

 accumulations : , in 

 transverse colon ; b, in 

 ascending colon ; c, in 

 transverse colon, be- 

 tween the double lines ; 

 d, in sigmoid flexure. 

 (After BRIGHT.) 



In faecal accumulation a large and hard, or doughy, mass may be 

 detected by careful examination ; it is best removed by persistent 

 massage and by enemata of soap and water. In the case of faecal 

 accumulation, as also of malignant tumour of the colon, pressure upon 

 the anterior crural, obturator, or other branch of lumbar plexus may 

 give rise to peripheral pains in loin, groin, or limb. 



Intestinal obstruction is often caused by a piece of intestine 

 being snared by a band of old peritoneal inflammatory tissue in the 

 pelvis or abdomen, by a Meckel's diverticulum (p. 325), by a rent in the 

 mesentery or omentum ; by a twist, and in many other ways. The 

 small intestine is more often strangulated than the large, and chiefly 

 so because it is more movable ; though, as regards a twist (volvulus}^ 

 the slackened folds of the sigmoid flexure are more frequently con- 

 cerned. 



Intussusception is the passage of a piece of bowel into that next 

 below it, the invaginated piece having the two peritoneal surfaces 

 against each other ; indeed, these surfaces becoming firmly glued 

 together, the invaginated and inflamed piece of bowel may slough off, 

 and pass per anum, the patient recovering. A common variety of 

 this form of obstruction is that in which the ileum passes through the 



