TORSION OF THE DOUBLE COLON 275 



Rectal examination then carries the diagnosis a step 

 farther. It reveals- the condition of affairs we have 

 described under the symptoms — namely, the clinging 

 clasp of the rectum on the inserted arm, the tightened 

 rectal mesentery, the presence of a gas-distended coil of 

 intestine thrust up against the exploring hand, and 

 forcible efforts on the part of the patient at evacuation. 

 Such symptoms as these are not met with in just ordinary 

 cases of impaction. It is plain indeed that serious dis- 

 placement or even actual twist has occurred. 



Now, however, comes a point of considerable diffi- 

 culty. At any rate, it has been a difficulty with me. It 

 is the matter of diagnosing rightly the significance of 

 the gas-distended intestine in or near the pelvis. The 

 difficulty arises in this way. In the main this chapter 

 deals with incomplete twist of the double colon at its 

 suprasternal and diaphragmatic flexures — a form of 

 twist which, as we shall afterwards show, is sometimes 

 amenable to treatment. In passing, it deals also with 

 complete twist of the same bowel, an affection which runs 

 so short a course, and is so palpably patent, as to in no 

 way confound our diagnosis. It so happens, though, 

 that we are not allowed to confine our attention to these 

 two conditions alone. If we were able to do that, then 

 the matter would be comparatively simple. But a 

 further form of incomplete twist — namely, torsion of the 

 pelvic flexure, forces itself on our notice, and simply has 

 to be taken into our calculations if we are to diagnose 

 our case correctly and afterwards to attempt treatment. 



By torsion of the pelvic flexure I mean a doubling or 

 bending over of the extreme end of the colic loop (see 

 Chapter XXL). In these cases the pelvic flexure is 

 doubled down out of reach. No portion of the colon can 

 be felt. In fact, in many instances, rectal examination 

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