Part 58

FOREIGN BODIES IN THE INTESTINES OF RUMINANTS.

Foreign bodies are usually arrested in the rumen of cattle and unless sharp, pointed or rough so as to cause mechanical trouble or caustic so as to act chemically, rarely do much harm. The most extraordinary objects that have found their way into the intestine are snakes. Gherardi claims that he found in the intestines a snake of 25 inches long; Jager found one of 21 inches in length, in an advanced state of decomposition, in the rectum of a calf. It is supposed that both had been taken in with the food. In each case there was obstruction of the intestine with severe colicy symptoms.

FOREIGN BODIES IN THE INTESTINES OF CARNIVORA.

Small bodies, especially playthings, feathers, hair, bristles, bones of prey. Lesions: congestion, inflammation, hemorrhage, ulceration, perforation, invagination. Symptoms: colic, vomiting, tucked up belly, straining, palpitation, rabiform symptoms, cough, convulsions. Course: emaciation, prostration, death in five days or two weeks according to seat of obstruction. Treatment: Oleaginous injections, laparotomy.

Causes. The dog is especially liable to this form of trouble, in consequence of his habit of carrying objects in his mouth and of playing with different objects especially the playthings of children. Marbles, pebbles, spinning-tops, corks, coins, nuts, peach stones, pieces of rubber, cloth or leather, bits of wood, sponge, needles, pins, potato, bone, cord, hair, bristles, feathers, wire, and a number of other objects. Some of them like feathers, hair, and bones are swallowed with food, and when that has been digested, they are either vomited or failing in this, are passed on into the intestine. Lately the author made a post mortem of a house dog with over 24 inches of the jejunum virtually blocked with fragments gnawed from a caouchouc ball and pieces of twine.

=Cats= also swallow a variety of objects. Benjamin and Megnin record three cases of intestinal obstruction by the crystal drops of shades.

Lesions. When the lumen of the intestine is blocked with a round solid body like a marble or peach stone there occur active congestion, inflammation, blood stasis and hemorrhage, with in many cases necrosis, ulceration and perforation. Similar lesions occur from cord. In a recent case of impaction with gnawed fragments of caouchouc and cord, the 24 inches of the bowel implicated were the seat of extended patches of necrosis and of deep, and even perforating ulcers on the lesser curvature of the intestine, evidently caused by the tension of the stretched cord on the shorter attached border of the gut. Cadeac says the lesions from cord are always at the point of attachment of the mesentery, whereas those coming from round or cubical solid bodies are mainly on the greater curvature. Mathis found at the pylorus a piece of net from which a cord extended through the small intestine and ended in a ravelled mass near the ileo-cæcal valve. The dragging of the cord on the intestine often causes invagination at one or several points.

Symptoms. There may be slight colic, dullness, a disposition to lie curled up in some secluded place, loss or caprice of appetite, vomiting, tucked up abdomen, arching of the back, straining, and unless the bowels are distended with gas, the obstruction can usually be felt by the two hands applied on opposite sides of the abdomen. The matters vomited are at first alimentary, then bilious and in the advanced stages always feculent.

The French veterinarians assure us that rabiform symptoms are very common as the result of obstruction of the intestines with foreign bodies. The indications are signs of fury without the barking which characterizes genuine rabies. The patient becomes wicked, cross and excitable, sometimes dull and morose, and snappish, his eyes glittering and his mouth frothy. He has alternate paroxysms of fury and torpor, at one time flying at and biting any living thing he meets, or tearing some object to pieces, and at another hiding away in secluded and dark corners. Massenat saw two dogs supposed to be affected by rabies, but which recovered promptly after having vomited the foreign bodies which they had swallowed. In a country where rabies is so prevalent as in France, it would be interesting to see the results of inoculation with some of the most pronounced of these rabiform cases.

Beside the rabiform symptoms cough and epileptic seizures occasionally result from the foreign bodies.

Course. Termination. Unless relief is obtained by vomiting or purging, appetite ceases altogether, emaciation advances rapidly, the animal becomes dull and stupid, being evidently poisoned by the absorbed toxins, and death may ensue in four or five days if the obstruction is near the stomach, or in one or two weeks if in the large intestines.

Treatment. The general treatment advised for the horse is applicable to the carnivora. Purgatives are always dangerous as threatening the overdistension and rupture of the bowel above the obstruction. Oleaginous and mucilaginous injections with manipulations are more promising if the obstruction is in the colon or rectum.

In many cases laparotomy is the only hopeful resort. Felizet and Degive have been quite successful in removing corks in this way, and Fröhner advises the operation to be performed under opium narcosis, and with antiseptic precautions. Make an incision of 1¾ inch near the umbilicus and parallel to the linea alba, extract the blocked loop of intestine, ligature it in front of the foreign body and behind it, incise, remove the offending mass and carefully close by sutures, bringing the muscular and serous coats in accurate opposition. Remove the ligatures, disinfect, return the bowel into the abdomen, close the abdominal wound with sutures and apply an antiseptic bandage.

If such cases are to be operated on it is important that it be done early, before the occurrence of necrosis, ulceration, perforation, or general infection.

RUPTURE OF THE INTESTINE. SOLIPEDS.

Causes: overdistensions in front of obstructions, softening, friability, necrosis, suppuration or ulceration, Duodenum from worms or perforation by pointed bodies, exudate in verminous embolism, petechial fever. Jejunum and ileum, by disease of walls, ulcers, abscesses, neoplasms, caustics in umbilical hernia, clamping of hernia. Cæcum, falls, blows, kicks, blows of horn, tusk, stump, calculi, abscesses, cauterizing of hernia. Colon, external traumas, calculi, worms, verminous thrombosis, neoplasms, abscesses, overdistensions, violent straining, arsenic. Symptoms: follow accident, signs of obstruction, no rumbling, tympany, stiffness, great prostration, fever. Death in short time.

Causes. Ruptures occur as we have already seen from overdistensions of the bowel in front of some obstruction, by ingesta, concretions, calculi, foreign bodies, etc., and this may take place in the most healthy organs. In other cases, however, there has been some pathological process at work rendering the intestinal wall soft, friable, necrotic, suppurative or ulcerative, by which its substance is attenuated or its consistency or cohesion reduced.

=Duodenum.= Lacerations of the duodenum are often connected with obstruction by tumors or the ravages of worms. These latter are mostly the ascaris megalocephala, accumulated in mass, and sometimes engaged in pouches outside the walls of the gut. In other cases, the walls of the intestine have been perforated by hard woody stalks of straw or hay (Mollereau) or of still more woody plants as in a case observed by the author, and in which the pylorus was perforated. Sometimes the exudate or blood extravasation attending on petechial fever, or verminous embolism will pave the way for the rupture. Perforations by pieces of wire (Schmidt) or other metallic bodies are also observed. Adhesive peritonitis has also rendered the walls friable and predisposed to rupture.

=Jejunum and Ileum.= Lesions are most frequent toward the termination of the ileum and resulting from obstructions of the bowel or the weakening of the walls by disease, or both. Ulcerations, abscess of the closed follicles opening into the peritoneum, and neoplasms of various kinds are to be especially noted among the causes. The impaction of the cæcum, blocking the ileo-cæcal valve is also among the observed factors. Other instances have been traced to deep cauterization of an umbilical hernia, the enclosed loop of small intestine becoming inflamed and perforated. The author has observed one instance from clamping of a hernia in which the contained intestine was adherent to the hernial sac.

=Cæcum.= From its position on the lower part of the abdomen and from its habitual plenitude with food or water, this organ is especially exposed to direct mechanical injuries and ruptures. A sudden fall, more especially if the umbilical region strikes on a stone or other projecting solid body, kicks with heavy boots or with the feet of other animals, blows with a cow’s horn or a boar’s tusks, and violent contact with stumps, poles and other objects may be the occasion of the rupture. These are usually found near the base of the viscus and across its longitudinal direction.

Inflammations, connected with punctures, calculi, parasites, etc., may render the walls so friable that they give way under slight strain or injury. Abscesses have been found in the walls of the viscus leading to perforation, and extension of inflammation from an umbilicus cauterized for hernia has determined adhesion and perforation.

=Colon.= The loaded colon is even more liable to mechanical injury than the cæcum. Occupying as it does the more lateral parts of the abdominal floor, it is even more exposed to kicks and blows, and extending as it does back toward the inguinal regions, it is especially in the way of blows of horns so often delivered in this region. From the solid nature of its contents the presence of calculi, the presence of blood sucking worms, and its implication in the congestions and extravasations of verminous thrombosis, this organ is especially liable to degenerations and inflammations which render its walls particularly friable. Neoplasms of various kinds, cancerous, tubercular, etc., have been found on its walls as occasions of rupture. Abscesses of strangles have ruptured into the viscus. Overdistensions in front of an obstruction in the pelvic flexure, floating colon or rectum are the most frequent causes of rupture. Again, cases have been seen as the result of violent exertions, as during straining in dystokia. It has been a complication of phrenic hernia, of volvulus of the double colon, and of ulceration caused by the prolonged ingestion of arsenic. In severe impaction the necrosis of the intestinal walls has proved a direct cause of laceration. The seat of these ruptures may be at any point, but it is most frequent in front of the pelvic flexure, or in the floating colon, or directly in the seat of impaction.

Symptoms. The attack comes on suddenly, perhaps in connection with some special accident or injury, and is manifested by violent colicy pains which show no complete intermission. In many respects the symptoms resemble those of complete obstruction of the bowel, there is a suspension of peristalsis, rumbling, and defecation, a tendency to roll on the back and sit on the haunches, an oblivion of his surroundings and pain on pressing the abdomen. Usually the shock is marked in the dilated pupil, the weak or imperceptible pulse, the short, rapid breathing, cold ears, nose and limbs and the free perspirations. Tympany is usually present as the result of fermentation. Signs of infective peritonitis and auto-intoxication are shown in the extreme prostration, unsteady gait, dullness and stupor, and general symptoms of collapse. The temperature, at first normal, may rise to 105° or 106° as inflammation sets in, and may drop again prior to death.

Termination is fatal either by shock or by the resulting peritonitis and auto-intoxication. Exceptions may exist in case of adhesion of the diseased intestine to the walls of the abdomen and the formation of a fistula without implication of the peritoneum.

RUPTURE OF THE INTESTINES IN RUMINANTS.

From blows of horns, tusks, etc., from rectal abscess. Symptoms: colic, resulting in septic peritonitis and sinking. Treatment.

Lesions of this kind usually come from blows with the horns of others. They may lead to artificial anus as in a case reported by Rey, or the formation of a connecting sac as in that of Walley. In a case seen by the author a large abscess formed above the rectum, from injuries sustained in parturition. This ruptured into the gut leaving an immense empty cavity in which the hand could be moved about freely, but which gradually contracted so that the cow made a good recovery.

André furnishes an extraordinary record of rupture of the colon, blocked by a potato. It seems incredible that a potato could have traversed the stomachs and intestine without digestion.