Intestinal Occlusion. T'otruius and intussusception are closely related pathological conditions, in \ ViliCh the fiecal stream is halted at the site of an obstruction so that no further evacuations are possible. Above the point of occlusion an accumulation of fecal material takes place, and this finally reaches such a degree that a reversal of the usual peristaltic current forces it back into the stomach, from Nvhich it is eventually vomited. Fecal vomiting is a symptom much dreaded by the physician, and in order to avoid it recourse must be had as early as possible to means for providing a natural exit. The attempt should first be made with enemas of various kinds and high rectal irrigations of warm water. These are sometimes successful in restoring the patency of the bowel. If constipation persists, it becomes necessary to seek surgical assistance. This is applied to the production of an artificial anus, usually on the right side of the lower portion of the abdomen. See ANUS, ARTIFICIAL. Through this artificial opening the faces are excreted, and are collected on pads of gauze or cotton, which must be frequently renewed, or in specially constructed receptacles. When the obstruction has been removed, and the lumen of the canal is again patent, the artificial anus can be closed ; otherwise it must remain open permanently.
Intestinal occlusion may come on suddenly or gradually. The acute variety may arise from the twisting of a loop of gut, from the in tertwisting of two or more loops (see Figs. 242, 243), or from the introversion of one segment of gut into another of larger diameter (see Figs. The peristaltic movement is interrupted at the site of the obstruction ; and it may even be reversed towards the stomach and produce fiecal vomiting. as already described. The intestinal coils above the occlusion become distended with gas and faecal matter, and the whole abdomen, or a part of it, becomes inflated like a drum. Inflammation of the peritoneum may set in, owing to the growth of bacteria in the swollen walls of the intestine. Where the occlusion is due to the gradual encroachment of a tumour, the symptoms are developed more slowly and are less severe in character. Weeks or months may elapse before obstruction results ; and this may be only temporary at first, but is certain to recur after a longer or shorter interval, and then becomes permanent.
Intestinal Tuberculosis.—In this disease the tuberculous process is localised in the intestine. It usually appears as a part of a generalised tuberculosis, and is rarely the primary focus of the disease. It is characterised by the development of numerdus ulcers of varying size, principally in the small intestine. These ulcers result from the disintegration of the so-called tubercles, a name given to the little nodules which are due to the growth of the tubercle-bacilli. In patients afflicted with pulmonary consumption the bacteria gain entrance to the digestive system by being swallowed with the sputum. More rarely they may enter the intestinal tract by the ingestion of infected food, such as milk from tuberculous cattle. The development of intestinal tuberculosis in this manner probably occurs only in children.
The tubercle-bacilli are especially liable to invade the mucous membrane of the intestine if a catarrhal condition is present. Months may elapse, however, before the ulcers are formed. The ulcerative process gradually extends into the deeper layers until the serous coat is reached, when perfora tion into the free abdominal cavity may take place, causing a suppurative peritonitis, which rapidly becomes fatal. More commonly, however, the ulcers extend in a lateral direction, and may cover the entire internal circum ference of the gut, leading later to the formation of cicatricial contractions of the lumen of the intestine. Small adjoining ulcers have a tendency to coalesce and form one large ulcer.
Tuberculous ulcers may exist in the intestine without giving rise to any symptoms. As a rule, however, abdominal pain is present, and very often fever, but the most characteristic symptom consists in attacks of uncon trollable diarrhcea. It frequently happens that the patient has from three to ten thin, fluid movements a day, as a result of which he rapidly becomes weak and emaciated. Together with the rapidly progressing pulmonary tuberculosis, the condition usually ends fatally within a few months, although occasionally it may linger for half a year.
The treatment of intestinal tuberculosis constitutes one of the most difficult problems in medicine. A strict diet, similar to that prescribed for chronic intestinal catarrh (which see), is necessary. Rest in bed, and the continued application of heat to the abdomen, are also of value. Among drugs, the best results have been obtained with tannic acid or its derivatives, taken in powder form, so that they may reach the gut undissolved and afford protection to the ulcerated surfaces. Bismuth is also employed ; and like wise a number of other drugs. By careful treatment it is sometimes possible to alleviate the diarrhcea for a time, but recurrences are very frequent. As the pulmonary tuberculosis improves, a change for the better is often seen in the intestinal conditions.
Intestinal Tumours.—Both benign and malignant growths are found in all parts of the intestinal tract from the duodenum down to the rectum. Of the two varieties, the former is the •rarer. Benign growths are mainly polypi, and are situated in the small intestine, where they form one or more finger-like proliferations of the mucous membrane, which are soft, freely movable, and of varying sizes. These are frequent sources of hmnorrhage, and may lead also to constrictions or invaginations of the intestine. As a rule, however, they are harmless, and do not endanger life. The first symptoms of their presence become manifest only when they interfere with the patency of the intestinal canal, causing transitory or permanent occlu sion of the gut, which may end fatally unless receiving prompt and energetic medical attention. Rectal polypi are the easiest to treat, because they may commonly be removed through the anal opening, while those situated higher up usually require an abdominal section.