INTESTINAL OBSTRUCTION of the intestine in the child is rarely clue to any other cause than intussusception or invagination of the bowel. Although any form of mechanical obstruction met with in the adult may conceivably arise in the young subject, such lesions are so uncommon in early life that when dis covered they have been placed upon record, less for their practical useful ness, than for the interest they may possess as pathological curiosities. Thus, the bowel has been known to be strangulated by peritoneal bands, or by the vermiform appendix ; to be obstructed by carcinomatous or lymphatic swellings ; or to be narrowed by congenital strictures. The temporary impaction of fatal matters which is sometimes found, is treated of elsewhere (see Constipation). A description of intestinal obstruction in the child practically resolves itself, then, into a description of intussuscep tion, and the present chapter will be confined to this subject.
Causation. —Invagination of the bowel, although an uncommon ac cident at any period of life, is more often seen in the young child than in the adult. Babies 'seem to be especially prone to it, for a large proportion of the cases occur during the first twelve months of life. This compara tive frequency of the lesion in infancy is attributed by Rilliet to the looser connections of the ccum in the iliac fossa at this age, and also to the im perfect development of its muscular bands, which lessens its resistance to the penetration of the small intestine into its interior.
In infancy, intussusception consists either of an invagivation of the small intestine into the larger, or of one portion of the colon into another portion. At a later period of childhood, the intussusception may involve the small intestine alone, without the larger gut being concerned in the invagination.
Infants and children in whom•this accident occurs, are usually sturdy and well nourished ; and the illness takes places suddenly, as a rule, with out being preceded by a period of feebleness or a state of ill-health.
Boys are more subject to it than girls. The causes which give rise to it are not always easy to determine. Drastic purgatives, indigestible food, violence of cough, external injury, and even rapid motion, as when a child is danced quickly up and down in his parents' arms, have all been quoted as exciting causes of the lesion. It is certainly curious to find that in many of these cases the symptoms of obstruction were immediately pre ceded by a fall- or other accident. In a case which lately came under my own notice—an infant of ten months old—the first symptoms followed a fall from his mother's bed on to the floor. Indeed, the child, when first seen, had a severe bruise on the temple and cheek, testifying to the severity of the accident. Still, if causes such as these were alone capable of de termining involution of the bowel, the accident would be surely more commonly met with than it is. In some recorded cases, intussusception has been preceded by intestinal catarrh ; and it is conceivable that any sudden increase of peristaltic action may help to induce it.
Morbid Anatomy.—In intussusception, one portion of the bowel is forced or invaginated from above downwards into another portion imme diately.continuous with it. At the point of invagination, therefore, a swell ing is seen which consists of three thicknesses of gut disposed one over another. Firstly, the external investing tube ; secondly, a portion con tinuous with this, which has been doubled inwards, or inverted within the first ; lastly, the contained portion of the bowel whose entrance into the first constitutes the lesion. Of these, the middle layer, which is of course reversed or turned inside out, has its mucous coat, now on its exterior, in contact with the mucous coat of the investing portion of the gut ; while its peritoneal coating, now innermost, is in contact with the peritoneal cov ering of the contained or invaginated portion of the bowel.