114 DISEASES OF THE STOMACH AND BOWELS 



in gastric dilatation. It may be necessary to use the tube 

 repeatedly to prevent ruptiu-e. 



Impaction of the Large Bowel. — ^Usually the impac- 

 tion occurs in the cecum, pelvic flexure of the colon or at 

 the termination of the right upper colon. Occasionally the 

 rectum is impacted (pregnant mares). 



Impaction of the Cecum. — ^The causes of cecal impaction are 

 practically the same as those of the small bowels. Usually 

 when the cecum becomes impacted it is due to an organic 

 change in the wall of the bowel which undergoes gradual 

 dilatation with thickening. Eventually, the walls of the 

 cecum lose their normal tonicity and paralysis develops 

 predisposing to impactions. As a result intermittent attacks 

 of chronic colic occur which generally lead to obstinate 

 constipation and eventually to toxemia, enteritis, ruptm-e 

 and death. 



Diagnosis. — An accurate diagnosis of cecal impaction can 

 be made only by rectal examination. In the right upper 

 flank region one can determine a swelling of about the 

 size of a human head. The enlargement is round, surface 

 smooth and is not sensitive. Sometimes the bands of the 

 cecum may be felt. The consistency will vary from quite 

 soft, doughy (retaining finger imprints) to firm or hard. The 

 fixed position of the enlargement, its size and location in 

 the upper right region of the flank make the diagnosis not 

 difficult. Error would be possible only in case there was 

 impaction with displacement of the left lower colon, the 

 bowel extending from the left to the right side of the abdomi- 

 nal cavity. The impacted left lower colon, however, usually 

 occupies the right lower region of the flank and hugs rather 

 closely the median line. The shape of the impacted mass 

 is furthermore elongated and, finally, the base of the cecum 

 can be felt in situ. 



Prognosis. — In early cases proper treatment usually pro- 

 duces healing. However, cecal impaction in the nature of 

 things tends to become chronic the patient suffering from 

 time to time with periodical attacks of pain the condition 

 finally leading to rupture and death. 



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