TORSION OF THE PELVIC FLEXURE 313 



the illustrations presented, it will have been noticed that 

 both of these cases of twist were only ' partial.' I 

 selected them for that reason, for my experience of these 

 cases goes to show that this ' incomplete ' torsion — just a 

 bending or doubling over of the bowel, without actual 

 strangulation — is the common or prevailing form of pelvic 

 twist, and that ' complete ' twist, to the extent of early 

 occlusion of the bowel, is a thing in this position 

 unknown. 



It is important to draw attention to this, for it serves 

 to explain two of the prominent symptoms in these 

 cases — namely, the passing during the early periods of 

 the attack of small quantities of faeces and flatus, and 

 the more or less gradual manner in which the grave 

 symptoms commence, only to surely gather in intensity 

 to the end. 



Both of these symptoms I think are explainable in 

 this way : The lumen of the bowel at the pelvic flexure, 

 although altered in direction, and no doubt compressed 

 at points, is not actually closed. This, it is conceivable, 

 allows of the passage only in small degree of both 

 faeces and flatus, and accounts for the presence in the 

 rectum of faeces of more or less normal consistence, and 

 for the absence of grave abdominal distension until near 

 the end of the case. It is not until the bowel wall, owing 

 to the eff^ect of pressure at the points of compression in 

 the bends, begins to undergo morbid processes due to 

 the stagnation of the blood-current, that actual stasis 

 and consequent great tympany occurs. 



If this explanation is correct, and it certainly bears 

 examination, then it is a point of great practical im- 

 portance on no account to be lost sight of when con- 

 sidering the treatment of these and allied cases. For 

 instance, it will be seen from this that with every hour 



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