Intestinal Obstruction

child, operation, air, bowel, symptoms, vomiting, chance and tube

Page: 1 2 3 4 5 6 7

Insufflation of air is best suited to cases where the intussusception has descended into the rectum and an enema returns at once. The air may be supplied by a common bellows, to the nozzle of which a caoutchouc tube has been attached, terminating in a long gum-elastic tube. Some lint must be wrapped round the base of this tube to enable it to fit closely within the sphincter. Air must be injected slowly, and at times the belly should be manipulated as in the former case. The process should be continued un til the large bowel is thoroughly distended with air, if this prove possible. In a favourable case, the mass will be felt to recede from the left iliac region, and then pass altogether from the reach of the finger. If this happen, we may have great hopes of having achieved our object.

These measures can only have a chance of success during the first three days. Certainly, after the fourth we can do nothing but harm by distend ing the bowel with either air or water.

In addition to the above methods, attempts have been made to replace the bowel by a long sound passed into the rectum, and have occasionally succeeded. This method is, of course, only applicable to cases where the invaginatiop. is within easy reach of the outlet. An aesophageal Bougie with a sponge fastened to its end forms a useful instrument for this purpose. If the above measures prove ineffectual, it becomes a question whether a sur gical .operation should be resorted to, or whether we should trust merely to complete rest and opium.

The operation of opening the abdomen and reducing the invagination with the fingers has been happily accomplished in some cases, and may offer a chance of success when other means have failed. Our decision as to its desirability will depend upon the opinion we have formed with regard to the tightness of constriction of the invaginated gut. As Mr, Hutchinson has pointed out, the imprisoned portion of the bowel may be tightly stran gulated, or merely irreducible, with comparatively little constriction. In the former case, the course of the disease is very rapid, and the symptoms are severe ; gangrene quickly supervenes, and death is speedy. In the latter, where the channel often remains pervious, although much narrowed, the course is more chronic, and the symptoms are less pressing. It is in these slower cases that the operation is especially likely to be successful. Un fortunately, the difficulty of judging of the degree of tightness of the con striction is very great. The severity of the symptoms is not always, in chil

dren, a trustworthy guide. Much depends in such a case upon the nervous impressibility of the particular patient ; for a degree of strangulation which in one child will produce violent vomiting and early prostration, will, in an other, be attended by much less serious and urgent symptoms. In young babies, unless the operation be performed within the first three days, and before the occurrence of collapse, we can have little hope of its success ; but as, in such cases, the death of the child, if left alone, is certain, the operation is surely a permissible one. In older children, I am strongly of opinion that it should not be performed if, from violence of vomiting, severity of the gen eral distress, and early occurrence of prostration, we have reason to believe the strangulation of the bowel to be complete. The gut would probably be found either gangrenous or adherent. In such cases there is always the last chance of sloughing and elimination, and this the operation would take away. On the other hand, if the general symptoms are comparatively mild, and especially if the intestinal channel is not completely occluded, the oper ation is distinctly called for after failure of other means of reduction.

In the early period of the illness, vomiting is often encouraged by re peated and unnecessary feeding of the child. At this time, it is best to give no food at all, and only to allow an occasional spoonful of barley-water to assuage the thirst. If old enough, the child may be allowed to suck lumps of ice. If the vomiting remits, some simple food—milk and barley-water for a baby, given cold with a teaspoon ; and for an older child, strong beef tea, essence of meat, and milk, also in small quantities at a time—may be allowed. When the strength begins to fail, brandy-and-egg mixture can be given.

If elimination of the gangrenous segment take place, the utmost care should be observed that for months afterwards the child eat sparingly of farinaceous and fermentable articles of food, so as to avoid injuring the young adhesion by flatulent distention. Potatoes, peas, and broad-beans should be forbidden. Farinaceous puddings and sweets should be greatly restricted in quantity. In fact, the child should be dieted much as if he had lately passed through an attack of enteric fever.

Page: 1 2 3 4 5 6 7