OBSTRUCTION BY FOREIGN BODIES AND CONCRETIONS.—The history of the case akne affords information, the varying greatly. It is only %, hen a sufficiently large foreign body be ,onics firmly impacted to excite tumefac non in the intestinal tissues that it gives rise to symptoms of acute obstruction similar to those defined. In obstruction due to gall-stones there is a history of hepatic colic and jaundice in a small portion of cases. The pain and vomiting occur early, the latter being severe from the start, and becoming s.tercoraceous in the majority of cases. A tumor being rarely detected, the differential diagnosis is difficult.
Case of a man, aged 70 years, who was sufTering from vague gastro-intestinal symptoms for about one year, when sud denly he w as attacked, while at break fast, with acute pain in the left side, midway betw een the umbilicus and the spine of the ilium. This was soon fol lowed by evacuation ot the bowels and vomiting, which became stercoraceous on the following day. Tympanites was moderate. Little pain on palpation. A tumor-like mass could be recognized be low and internal to the sigmoid. A probable diagnosis of volvulus having been made, an operation was performed, which revealed an impacted gall-stone 4 ', , by 6 inches in circumference and 2 inches in length.
Possibilities of spontaneous evacuation of the stone is possible in from 30 to 50 per cent. of the cases. The remaining 50 to 70 per cent. will die if not relieved by operation. The mortality from the operation is. also very high. vom iting should be the signal for operative interference in any form of obstruction hen other means fail. Lavage is of very great value even in cases surgically treated. When employed before the oper ation it prevents vomiting. Lord (Jour. ...liner. Med. Assoc., Oct., '9S).
The diagnosis from other disordere must be established. Most prominent among these are colic, acute enteritis, acute generalized peritonitis, and acute hmmorrhagic pancreatitis.
Conc.—The abdominal pain usually termed "colic" is often associated with the temporary retention of fweal matter in any part of the intestine or any local irritation, but the spasmodic character of the pain, its broad distribution from side to side, and the absence of any localized spot of sensitiveness usually facilitate recognition of the condition present.
The prompt relief obtained from reme dial measures, the response to purgatives, and the general history of the case usu ally place the diagnosis on a solid foot ing. -Vomiting and collapse may also attend cases of cholera morbus, but fcal vomiting only occurs in obstruc tion.
The location of pain does not imply that the obstruction is there. In ob struction of the small intestine pain is apt to be located about 2 inches above the umbilicus at the site of the solar plexus; and if not adherent the small intestines constantly change position. If the obstruction be in the colon, the location of the pain might be of some service in making a diagnosis of the bow el involved, as the colon does not have nfuch latitude of motion; and pain having its origin in the colon is not apt to be referred to the solar plexus. Con tents of the intestines do not become feculent until near the ileo-crecal valve; hence the voiniting of fxcal matter w-ould imply obstruction in the colon or the lower portion of the ileum. An ob struction in the upper jejunum is usually attended with profuse vomiting of thin, bile-stained fluid, non-feculent in char acter, yet by rapid decomposition or long distension the odor of the contents of this portion of the bowel may become ver:v offensive. A. H. Cordier (Jour. Amer. Med. Assoc., Feb. 4, '99).
ACUTE ENTERITIS.—Irritant poisons also give rise to symptoms simulating intestinal obstruction, but we have the history, the probable presence in the vomitus of the toxic azent inz,ested, or of food liable to assume poisonous prop erties. As a rule, there is also violent diarrhcea, possibly tinged with blood; raised temperature; intense pain, lo cated, not only in the abdomen, but also in the stomach, and generally referred to the "pit" over this organ—all character istic signs. Though the later stages of a case of acute enteritis may be attended by collapse and other symptoms of obstruc tion, fmcal vomiting is always absent.