Acute Intestinal Obstruction Diagnosis and Treatment

Acute occlusion of the intestinal canal is a condition always to be dreaded, for it begins suddenly and unexpectedly and, unless relieved, hurries to a fatal issue due either to shock or sepsis. Perhaps, as Bloodgood says, the condition is not frequent, yet, none the less, it is an emergency whose character must be thoroughly understood. But for that matter its character is variable, depending on the cause. To simplify the subject, the obstruction due to strangulated hernia is not considered here, for in such cases the cause of the obstruction is quite obvious; nor need we consider postoperative ileus, for it has a pathology of its own; again the obstruction which may accompany appendicitis is in a class by itself. The acute obstruction to be studied includes those changes in the form or direction of the bowel or these accumulations within its lumen which completely and suddenly dam the focal current, whether it be a kink or twist in the gut; a volvulus or intussusception, an adhesive or constricting band, relic of a former peritonitis; an accumulation of gall-stones or cancer: whatever the source of the obstruction, the danger arises, as has been said, from two sources—shock and sepsis. By far the lesser of these two is shock In many cases it may be absent, and even when it is the dominant feature early in the attack, it may gradually subside, The sympathetic plexuses seem able to regain their balance and adjust themselves to new conditions. For this reason attacks which begin with collapse often seem to improve in a short time, But such improvement is deceptive, for sepsis pursues its insidious course, the bowel becomes more distended, its peritoneal coat more inflamed, so the intestinal bacteria find their way into the peritoneal cavity and their toxins into the blood. It is stercoremin, therefore, which is to be dreaded, for there is no way to measure its progress with any certainty... <Callout type=