440 
DEPARTMENT OF SURGERY. 
arrest the flow of the contents of the intestine, which can be re¬ 
lieved by the removal of the contents through an opening made 
in the intestine, and the causes of such occlusion may be enu¬ 
merated as follows, viz.: 
{a) Calculi. 
(b) Strictures. 
(c) Tumefaction. 
(at) Dilatation of intestine. 
(e) Change in relation of intestine. 
(a) Calculi .—A calculus seldom causes an occlusion in itself, 
but in many cases it is the primary cause of the occlusion ; very 
few of them exceed eight or ten centimeters in diameter; hair 
balls ( cegagropilce ), which produce the same disorder, are usu¬ 
ally larger than calculi. In many instances the calculus causes 
a tumefaction of the walls of the intestine by irritating them, 
and this hypertrophy of the wall lessens the calibre of the in¬ 
testine and eventually almost or entirely closes it, and requires 
a resection of the part thus affected in addition to the removal 
of the contents. The symptoms of intestinal occlusion due to 
calculi are the same as in coprostasis, but now and then a cal¬ 
culus may be found in the excreta, and when such conditions 
cannot be relieved by medication, enterotomy is the only resort. 
To this classification may be added all obstructions that are 
caused by foreign and indigestible substances. 
(b) Strictures .—These may be caused by a constriction of 
the circular muscular fibres or a hypertrophy of the walls; the 
exciting cause being generally an injury, a chronic catarrh of 
the intestine may produce a hypertrophy ; helminth may cause 
the same condition or any injury that will cause a cicatrix. 
Anterior to these strictures is usually a dilatation caused by the 
increased pressure resulting from the arrest of the contents of 
the intestine. Enterotomy may relieve the condition tempo¬ 
rarily, but if the stricture greatly reduces the lumen, it should 
be resected. 
(c) Tumefaction of the walls of the intestine will reduce the 
calibre of the intestine and the contents will accumulate ante¬ 
rior to the constricted part and form a dilatation. These tum¬ 
ors may be cancerous or sarcomatous, and may require abla¬ 
tion, but if the temporary condition is accidental, due to faulty 
dieting and the patient unable to withstand the removal of the 
tumefied portion, the contents of the intestine may be removed 
by enterotomy, but in such instances the relief would be only 
temporary ; a resection is the only radical method to adopt. 
