330 Intestinal Obstruction 



ileo-caecal valve ; ileum, valve, and caecum may all slip into the colon 

 and even hang into the rectum, so that in every case of obstruction 

 the finger should be passed into the anus. In most of these cases 

 bloody discharge occurs from the anus ; the piece of intussuscepted 

 bowel stimulates the ensheathing piece, and painful straining to pass 

 a motion (tenesmus) results. Where there is much faeculent or bloody 

 discharge there is not much inflation of the bowel. The intussuscepted 

 piece, like a ball of snow, grows larger as it travels onwards, and j^ivrs 

 rise to a tumour which may be felt through the abdominal wall, in the 

 course of the colon. 



When obstruction is high in the small intestine the patient is sick 

 each time he takes anything into the stomach ; thus the amount of 

 urine must be greatly reduced ; moreover, he perspires profusely, the 

 skin doing some of the work of the kidneys. The more constant the 

 vomiting, the less must be the amount of gas in the alimentary canal ; 

 in some cases of obstruction high in the jejunum the abdomen is 

 flatter than normal. But as peritonitis sets in tympanites, of course, 

 supervenes. When the small intestine is inflated and the abdominal 

 walls are stretched the position of the transverse rolls may be felt and 

 seen behind the recti. These elevations must not be mistaken for the 

 natural segments in the muscles which occupy fixed and definite 

 situations. 



When obstruction is low in the large intestine, as in the case of a 

 laden sigmoid flexure becoming twisted, or narrowed by malignant 

 constriction, there may not be much vomiting, but the Abdomen is 

 greatly distended by flatus, and there is resonance in the flanks in 

 the course of the ascending and descending colon. 



Borborygmi, or ventral rumblings, are caused by the irregular 

 passage of gas along the bowels, and are probably due to disturbance 

 of peristaltic action through the influence of the sympathetic system. 

 It is also by some irregular contraction of the circular fibres that a 

 piece of small or large intestine is slipped into and strangulated by a 

 piece of the bowel lower down (see also p. 329). The introduction of 

 food into stomach or rectum increases peristaltic action, so that nothing 

 but a little ice can be allowed in acute intestinal obstruction. Opium 

 is given to check peristaltic action. Strychnia is used in chronic forms 

 of constipation to excite peristalsis. 



The arteries of the large intestine are ileo-colic, right colic, and 

 middle colic from the superior mesenteric, and left colic, sigmoidean, 

 and superior hrcmorrhoidal from the inferior mesenteric. (For the 

 supply of the rectum see p. 388.) 



The veins are tributaries of the vena porta?, except those coming 

 from the lower end of the rectum, which open into the internal pudic 

 vein. The nerves come from the aortic plexus, and the lymphatics 

 enter the lumbar glands. 



Xiittre's operation is making an artificial anus in the sigmoid 



