OBSTRUCTION, INTESTINAL (IL Elf S) Definition.—A complete or partial oc clusion of any portion of the intestinal canal, caused by strangulation, intussus ception (invagination), twisting or knot ting (volvulus), strictures, tumors, fa:cal impactions, concretions, or foreign bod ies. The occlusion may occur suddenly, causing acute obstruction, or be of gradual development and but reduce the diam eter of the intestinal canal: chronic ob struction. An acute obstruction may be come chronic and a chronic case may be come acute; it is, therefore, sometimes difficult to determine accurately the con dition which we have to deal with, for one form may take on a few or many of the symptoms of the other (Keen).
Gener al Symptomatology. — ACUTE OBSTRUCTION.—Colicky pains coming on suddenly after a more or less prolonged period of constipation and nausea are the earliest symptoms witnessed in the majority of cases. ..A.t first paroxysmal, the pain soon becomes continuous, the suffering increasing steadily in severity. Nausea is soon followed by vomiting, which also increases in severity until it constitutes a most distressing symptom. The contents of the stomach are first voided; this is followed by a greenish fluid stained with bile, which becomes brown, and finally stercoraceous, emit ting the characteristic acal odor. Con stipation is persistent, though bloody mucus and a small quantity of 12ecal matter (that below the obstruction) may be discharged per cumin. There is dis tension of the abdomen with tympanitic resonance; this constitutes the most constant of the local signs. This abdo men is very sensitive to the touch when the case has progressed some time. Bor borygmus and gurgling may be detected on auscultation.
The general symptoms indicate the grave character of the disease present. The features are pinched and the entire surface cold and clammy, the ture being subnormal. The eyes are sunken; a bluish-black tinge around them and beneath the nostrils gives the face a cadaverous expression. Thirst is usually marked, and the mouth and tongue are dry. The pulse is rapid and feeble and sometimes irregular, the breathing being correspondingly more frequent. The urine is scanty and high
colored; in some cases there is anuria. Finally all the evidences of imminent collapse appear, and the patient, if relieved, passes into coma. Death may occur in from two to six days after the first manifestations.
Two cases of asphyxia from vomiting in intestinal obstruction, in both of which the patients, suffering from acute symptoms of obstruction, vomited in the early stages of the ansthesia such enor mous quantities of fluid as to interrupt respiration. J. Ernest Stokes (Annals of Surg., Sept., '97).
Obstruction of the small intestine is more likely to cause severe shock than that of the colon.
In case obstruction is complete, pain will be constant, yet periods of intensi fied suffering will repeatedly come on. If the obstruction is only partial, the liquid contents and gases will be forced past the constriction, and for a time the peristaltic pains will subside and the patient ill be free from sufTering until more gas is generated or another reflex wave is excited. In intussusception the constriction, early in the case, is usually incomplete, hence the pain is not so severe; there is no tenderness on press ure, and sometimes firm pressure relieves the pain. Many eases of obstruction de velop septic peritonitis. A. H. Cordier (Jour. Amer. Med. Assoc., Feb. 4, '99).
Ctt 'ay\ it. 0 u chronic J-tr;ittion. the most frequent cause of II is fa.eal impaction, obstinate con = ;;,;;atitin usually follows a prolonged ri_a1 (luring which the intestinal func t w t ebaracterized by great irregn larity—stteral days' constipation per L'1Z 5 followed by the elimination of hard ( tictl 1112S(.5. presenting various shapes, round balls reseniblin,e! the heces of small rhit °roils animals, sheep, rabbits, etc., la. softer matter, ribbon or pencil shaped, tl e mass remaining within the intestine at a obstructing it presenting a channel through which the freces passed are melded. Mucus is also voided, sometimes ;n large quantities.