POST-OPERATIVE OBSTRUCTION. — testinal obstruction following operation is caused, according to Deaver, either by paresis, the result of traumatism or sep sis, or a combination of these, or to me chanical causes. About 2 per cent. of deaths following abdominal section are due to mechanical or true intestinal ob struction. The plost important form occurs when the intestine becomes ad herent to a fixed surface which has been denuded of peritoneum. As a result of the adhesion the bowel becomes kinked and immobile. Obstruction may also occur as a result of adhesion of the bowel to neighboring coils of intestine; here another factor usually comes into play: bending of the bowel over the brim of the pelvis or over the omentum whose free edge has become attached. Still another variety occurs from bands of adhesions running from one place to another, under which a knuckle of gut aml becomts fixed. A variety of purtiv mechanical obstruction and one that should never occur arises front in c...tdin; a portion of the bowel in a liga ture. A knuckle of gut slipping through a in the omentum may also give rise to obstruction of the bowel as a re sult of abdominal operation.
CLrtain number of post-operative oc clusions of the intestines arc due to the physiologrical impermeability of the left subcostal angle of the colon. \\lien tbe small intestine is placed in a plane pos terior to the angle ot the colon, this angle is not compressed and its permea bility is less liable to ne interfered with. Adenot (Gaz. Ilebdom. de Med. et de Chir., Mar. IS, '95).
The statistics of Spencer Wells and Fritsch both give about I per cent. of intestinal obstruction as the proportion after ovariotomy. The writer comments on fifty-seven cases which he has been able to collect, and finds that twenty seven of them followed ovariotomy, and apparently as often after simple cases as after the more complicated ones. The symptoms of obstruction supervened either early in the case—i.e., within ten or fifteen days, and most frequently from the third to the fifth—or they were post poned to a much later date, such as months or years subsequently. F. Le
gueu (Gaz. des Hop., Nov. 23, '95).
It is estimated that from 1 to 2 per cent. of deaths after laparotomy occur from intestinal obstruction.
Many eas.es diagnosed as sepsis are primarily obstruction.
The symptoms of post-operative ob struction are vomiting first of undigested food and fluids, later of a bilious charac ter, and finally .stercoraceous; shock and inability to pass fxces, or flatus; but, if the obstruction be high up, pas sages from below the obstructed point may be discharged. Hugh M. Taylor .Va. Med. Monthly, Jan., '96).
Seven cases of intestinal obstruction following laparotomy seen, five of which were fatal. The obstruction always oc curs in the small intestine near the seat of the operation, and most frequently quite near the junction of tbe small and large intestines.
There are no clear-cut, positive symp toms. There is a wide difference in the symptoms from those which indicate the usual acute intestinal obstruction. In none of the cases was the integrity of the intestine involved; probably the opera tion had so lowered the vital forces that paralysis of the bowel took place, peri stalsis cea.sed, and septic poisoning oc curred through accumulation of the se cretions of the bowel. The main symp toms in these cases are persistent vomit ing, which is of much more significance when it comes on several hours after the operation and is not due to the anms thetic; pain, which might be local or general, and frequently is not severe. The temperature is not usually marked, but the pulse is rapid and there is a peculiar, anxious expression of counte nance which is quite characteristic. H. O. -Marcy (.Med. Rec., May 23, '96).
Post-operative intestinal obstruction is due to tonic muscular spasm, to true intestinal paralysis, to the formation of new adhesions, or to pre-existing con striction not discovered or relieved at the time of operation. Boise (Med. News, July 1S, '96).