DEPARTMENT OF SURGERY. 
441 
(d) Dilatation of the Intestine .—Dilatations may result from 
impaired nerve supply, prolonged obstructions, accumulation 
of indigestible substances, strictures and tumors. Those that 
are caused by impaired nerve supply to a part of the intestine 
are usually partly filled with the contents of the alimentary 
tract, and can be relieved by enterotomy and reduced to its nor¬ 
mal size by suturing ; those caused by prolonged obstructions 
may be treated in the same way, the contents removed and the 
incision sutured; and those resulting from a stricture and 
tumor fnteroncus) require a resection and also a reduction of 
the calibre of the dilated portion. 
(e) Change in the Relation of Intestine .—These obstruc¬ 
tions are more common than those caused by other means. 
The cause of the occlusion of the intestine due to intestinal 
alterations may be as follows, viz. : 
First: Volvulus. 
Second: Intussusception. 
Third: Intestinal strangulation. 
Firstly, volvulus is more common to the small intestine and 
floating colon, than in the large colon, and consists of a rota¬ 
tion of the intestine upon its longitudinal axis. An occlu¬ 
sion caused by a volvulus that has existed for a long time,, 
should be treated by removing the contents that have accumu¬ 
lated anterior to the volvulus by enterotomy and replacing the 
intestine in its natural position. 
Secondly, an intussusception or invagination consists of the 
passage of one portion of the intestine into the lumen of the 
other, and in this manner occludes the opening and arrest the 
passage of the ailment. The site of the invagination is usually at 
the csecurn ; and the following varieties may be observed, viz. r 
the ileal , in which the ileum passes into the caecum ; the ileo- 
ccecal , when the ileum and the ileo-caecal valve protrude into the 
caecum ; colic , when the large colon extends into the caecum ; 
and, the ileo-colic , when the ileum extends through the caecum 
into the colon. Each of these conditions may produce an ob¬ 
struction, and require the removal of the accumulated aliment 
by enterotomy and the restoration of the intestine to its normal 
position. 
Thirdly, intestinal strangulations may be caused by the pas¬ 
sage of the intestine through the foramen of Winslow, the in¬ 
guinal ring, perforations of the mesentery, omentum or broad 
ligament. The treatment of these occlusions consists of reliev¬ 
ing the strangulation, and if the accumulation of the contents 
