INTUSSUSCEPTION. — Intussusception, or invagination of one portion of in tt.;:.tie into another portion of the same, mainly due to irregular peristalsis, t, -tilting. in turn, either from consti pation. diarrliwa, colic, or paralysis. ,Ntarlv 40 per cent. of the cases occur in children. In a series of 300 fatal cas,e,,, from some form of intestinal s:ruction, Brillion found that 215 were due to inva.c2ination. In 103 cases Icctul from literature Wiggin noted that 50 per cent. occurred during the fourth, fifth, and sixth months in equal tions, 75 per cent. of the patients being males.. All but 1:.? cases were of the ileo-clecal variety. In this variety the ileo-ciucal valve becomes invaginated into the colon, its much larger continuation, and may thus reach down to the anus, as witnessed in a case reported by Lange. The other varieties, met with in about lu per cent. of all cases, are the colic, in which the lower portion of the ileum passes through the ileo-cmcal valve; the ileal, in which the ileum is alone the seat of invagination; the colic, in which the colon is alone involved; and the colico-rectal, in which the colon is invaginated into the rectum.
Intussusception ith the passage of a portion of the intestines twenty-nine inches long on the fifteenth day, wit nessed in a woman aged 56 years. Edi torial (Edinburgh Med. Jour., Apr., '88).
Sixty-four cases of intussusception observed in children within a period of twenty-one years; the majority--46 cases—were boys. The age at which the trouble occurred most frequently was from the third to the ninth month, more than one-half the eases occurring at this period. Among the 46 infants under 1 year, 39 were exclusively breast-fed. Only 2 were bottle-fed from birth. Hirschsprung (Jahrbuch f. Kinderh. u. phys. Erzie., B. 39, 4, '95).
Intussusception is the cause of fully 30 per cent. of all cases of acute obstruc tion. The greatest proportion of cases of intussuseeption, fully 50 per cent., occur in children under ten years of age, and of these rnore than 50 per cent. oc cur in infants under twelve months. 13etween the ages of five and forty to fifty the number of cases diminish, and after forty or fifty the frequency of oc currence is again noted. This condition
may be explained upon the grounds of periods of debility, occurring in infancy and extreme adult age. J. F. Erdmann (Med. News, Dec. 24, '9S).
Careful search made through the rec ords of the Children's Infirmary of Liverpool, and it was found that out of 130,000 new patients there were only 16 cases of intussusception. Of these 16 cases only 7 recovered. The age at which intussusception usually occurs is somewhere between the fourth and sixth months of life. Murray (Liverpool Medico-Chir. Jour., Jan., '99).
According to Nothnagel, invagination, or intussusception, is brought about by contraction of the longitudinal muscular fibres of the portion of intestine that overrides or receives the upper portion within itself, the irregular peristalsis of the invaginated portion assisting. Thus telescoped, the two lengths of intestine form a cylindrical mass varying in length up to two feet or even more. Three layers of intestine are thus superposed: the external (intussuscipiens), or ing layer, acting as sheath for the in vaginated portion; the middle layer, and the infernal (intussusceptum) layer.
By application of a ligature to the intestines of an animal it was found that if it be applied sufficiently tight to cause complete obstruction, violent peri stalsis is caused above the scat of liga tion, but that no antiperistalsis is pro duced. Frecal vomiting- is accounted for by the fact that in the direction of the stomach least resistance is encountered. Nothnagel (Y. Y. Med. Jour., .A.pr. 13, 'S9).
The evidence derived from anatoruical, physiological, pathological, and clinical data renders it legitimate to assert that spontaneous ileo-crecal intussusception occurs w the colon is considerably larger than the ileum. and is so unduly movable that it readily allows itself to become invaginated when once the proc ess has begun. This variety of intussus ception is essentially an affection of childhood, and such an undue increase in the width of the colon implies either a congenital abnorinality or an unduly rapid growth, for at birth the diameter of the large intestine is practically the same as that of the ileum.