Treatment by operation is a very se vere proceeding in infants and quite young children, and is often followed by death.
In 64 cases of laparotomy undertaken for the relief of intussusception in in fants under one year of age, 21 recovered and 43 died. Pickering Pick (Quarterly Med. Jour., Jan., '97).
In intussusception, distension of the bowel with gentle external manipula tion should be tried in recent acute cases, the surgeon being present and pre pared to operate at once if these means t... 111.1,11. 11 be contra-indicated erity of the symptoms or their roi iN it). t ;Feat care -110111,1 be taken t at the reduction of the intussusception 1- ,011tpfite: thickening about the ,11 Nal“. Illay ,1111111ate incomplete rcluction, so that when in doubt the rt should be examined throug,h an in (isien in the bowel. Any attempt to fix ilk 1.0)N-el after reduction by sutures st. N t o be coin ra • indica ted. Small:..110111N1 be given after t ion. When reduction is impossible,re-eetion throuLdt an incision in the Nolon seems to give the best chance, the junction between the large and small bowel beinL, made secure before any part i- cm away. D'Arcy Power (Jour. Path. and Bact., June, '97).
inflation sholild be tried only when the case is seen within a few hours of onset and is not of a very acute char acter. In the great majority of hospital caes it is better to open the abdomen at once. Inflation may also be tried in certain other cases for the purpose of reducing the main portion of the in tussiisception and enabling the incision to be made directly over the cfecum. When reduction is found hnpossible chronic eases a resection may be gen erally done through an incision in the insheathint, bowel. In acute eases, and especially if gangrene is pres,ent or the condition of the bowel requires its re moval, a wide resection should be under taken as rapidly as possible, and the ends broindit outside the abdomen; con tinuity should be restored at a. snbse quent operation. In exceptional cases of enteric intussusception resection and immediate restoration of continuity gives the only chance. Bernard Pitts (Brit. Med. Jour., Sept. 7, 1901).
Out of 33 cases of intussusception treated by enemata or inflation, recorded by Fitz, 22 were saved. WigErin lected 39 cases of the same kind in 23 of which these measures proved success ful. Recurrence is apt to occur in in
tussusception, however. This is ascribed by,- Frederic Eve in the large class of ileo cmcal intussusceptions to the ileo-ctecal orifice still remaining slightly invagi nated into the cmcum.
In intestinal obstruction following laparolomy H. O. Marcy states that in jections are of no use. A careful ex amination of the intestine should be made at the site of the operation, then in the region of the appendix, and then of the omentuna, and the obstruction will usually be found. If this is done early the difficulty can be corrected. In desperate cases an incision may be made in the abdomen; the first inflated coil of intestine seized, attached to the wound, and opened, establishing an arti ficial anus; and thus the patient is car ried along until a thorough and radical operation can be performed. As a pre vention of this complication he believes that careful suturing of every abrasion of the peritoneum is of great value.
The tyrnpanites, besides adding to the sufrerim-,,, sometimes prevents the expul sive effort of the intestine, by totally arresting peristaltic action. The chances of reduction are greatly increased in some cases by elimination of the intes tinal gases. Sweetnam reduces tympa nites by posture. In very- extreme dis tension he recommends the knee-chest position, but in cases of moderate dis tension he places the patient upon the side and elevates the foot of the bed. It may be necessary to keep the hips in the elevated position for ten or fifteen min utes before the contents of the abdomi nal cavity gravitate sufficiently from the pelvis to enable the upper portion of the rectum to pass out of the pelvis toward the abdominal cavity.
Relief will not be secured until this occurs. In marked tympanites the dis tension is practically confined to the large intestine. and obstruction to the escape of flatus is due to the downward pressure of the descending colon and sigmoid flexure upon the upper portion of the rectum, forcing the folds of Hous ton one upon the other and bringing about, for the time being, an imper meable stricture. An attempt to pass this by the soft-rubber tube will fail, be cause the tube will coil upon itself. Tur pentine stupes and hot applications are excellent adjuvants.