Part 60

Dilatation of the rectum into a cloaca is found in the horse and ox, often connected with disease or injury of the terminal part of the spinal cord, and is very common in dogs and cats in connection with the compulsory retention of the fæces indoors. Pigs also present instances of the kind.

The symptoms are in the main slight colics, with or without tympany and recurring after each meal. In the small animals the distended gut may often be recognized by palpation through the abdominal walls, and in the larger animals by rectal exploration. The distended viscus has not the firmness nor hardness of impaction or calculus and is mainly recognizable by its bulk and form. When the distension is in the rectum it may be easily reached and contents dislodged with the effect of giving complete relief for the time being.

Treatment. Treatment is necessarily mainly palliative and consists in the removal of abnormal accumulations. From the rectum this can be done with the hand, or in the smaller animals with the finger. For abnormal dilatations more anterior, purgatives and mucilaginous injections are required, with kneading of the bowels through the abdominal walls, or through the rectum in the larger animals, and stimulation of the peristalsis by nux vomica, ergot, barium chloride or eserine.

Having unloaded the dilated portion of any undue collection, further accumulation should be guarded against by giving nutritious food in small compass, and of a laxative nature, by stimulating peristalsis by nux vomica or other nerve stimulant and by the daily application of electricity. Enemata and laxatives should be employed when necessary.

STRICTURE OF THE INTESTINE.

From healing of ulcers, inflammation or infiltration, neoplasms, ring like or sacculated, in small intestine in horse preceded by a dilatation, an effect of verminous thrombosis; in cattle; in dog. Symptoms: Progressive, if in duodenum can’t eat full meal, belches gas, has colics and tympany; in cattle tympany, unthrift; in dog vomiting, tympany, colic, accumulations. Treatment: Gradual stretching by bougies if within reach.

Strictures of the intestine are in the main the result of ulceration of the intestinal walls which contract in healing, or inflammation, and infiltration which leads to contraction in their organization into tissue. Neoplasms of the walls (cancer, myxoma, lipoma, polypus, melanosis, actinomycosis, tubercle) are additional causes of constriction. If resulting from a lesion which completely encircled the bowel there is an uniform constriction in the form of a circular ring; if on the other hand it started from a longitudinal ulcer or lesion the bowel is shortened on that side and puckered.

In =solipeds= strictures are most frequent in the small intestine, or rectum. The pylorus is often affected. When on the small intestine there is constantly a dilatation just in front of the obstruction. The constricted portion is usually short, but as seen from outside of the gut may be duplicated a number of times. Cadeac mentions seventeen such strictures in the same animal, each preceded by a dilatation. The individual stricture may be less than two inches in length and so narrow as just to allow the passage of the index finger. The walls of many times their natural thickness, are still further thickened by an external layer of adipose tissue. It may be the seat of a small abscess, or of a tumor. Internally the mucosa may show ulcerations.

The stricture or strictures in solipeds often depend on the disturbance of the circulation which results from verminous thrombosis, the exudate into the intestinal walls, undergoing organization, at once thickens and constricts the tube, and determines as secondary result the dilatation in front of it.

Professor Mauri of Toulouse records the case of a horse with a rectal stricture 4 inches from the anus, and a great dilatation in front. The removal of the stricture, secured normal defecation, (whereas before this the fæces had to be removed by hand) and the colics entirely disappeared.

In =cattle= strictures have been found mainly at or near the pylorus, less frequently in the rectum, and on one occasion (Revel) in connection with a cancerous tumor, in the colon.

In the dog the pylorus is also the favorite seat of thickening and stricture, yet it may occur in the small intestine, the rectum, or the colon.

Symptoms. These are gradually advancing, as the stricture approaches more and more nearly to a complete stenosis. If the stricture is in the pylorus or duodenum, the patient can not eat a full feed of grain without discomfort. He stops, hangs back on the halter, plants the fore feet in front, arches the neck, drawing in the nose and eructating gas. If he cannot eructate he is liable to show colics, tympany, and the general symptoms of gaseous indigestion of the stomach.

In =cattle= there is tympany, partial loss of appetite, tardy rumination, and loss of condition.

=Dogs= show vomiting as a prominent symptom. When the stricture is in the rectum there is a gradual lessening of the amount of fæces passed at a time and an accumulation of feculent masses in advance of the obstruction, recognizable by rectal exploration. When in the terminal part of the small intestine or in the colon, a gradual lessening of defecation, with tympanies and colics, culminating in complete obstruction, may afford a suggestion of the trouble but no means of certain diagnosis. In the smaller animals some additional indications may be had from abdominal palpation.

Treatment is usually hopeless unless the stricture is in the terminal portion of the rectum. In the latter case gradual dilatation by the passage of the hand, the finger, or of bougies which are used larger and larger, as they can be forced through with moderate pressure may secure a sufficient dilatation. Forced dilatation, or even careful incision at several different points of the circumference of the stricture may give good results in certain cases.

INTESTINAL INVAGINATION. INTUSSUSCEPTION IN SOLIPEDS.

Definition. Seat: ileum into cæcum, rectum through sphincter, duodenum into stomach, floating small intestine into itself, cæcum into colon. Lesions: blocking, or tearing of mesentery, dark congestion, peritoneal adhesions, incarcerate gut, necroses, sloughing of invagination. Symptoms: colics of obstruction, enteritis, and septic infection, eructation, emesis, tenesmus, signs of sepsis and collapse, death in seven hours or more, or recovery by disinvagination or sloughing. Diagnosis: by rectal exploration or passing of slough. Treatment: oily laxatives, demulcents, enemata, mechanical restoration of everted rectum, laparotomy.

Definition. The sliding of one portion of an intestine into a more dilated one, as if a few inches of the leg of a stocking were drawn within an adjoining portion which is continuous with it.

Seat. It is most commonly seen in the inversion of the small intestine into itself or into the cæcum, or next to this the passage of the rectum through the sphincter ani, to constitute eversion of the rectum. It would appear to be possible at any part of the intestinal canal in the horse, in which the bowels are more free to move than they are in ruminants. Peuch records a case of invagination of the duodenum into the stomach and Cadeac gives a woodcut of such a case, which one would suppose the fixed position of the duodenum would render impossible. It is conceivable that the jejunum could be invaginated into the duodenum, and that this should have continued until it extended into the stomach, but it is difficult to see how the duodenum itself could have passed into the stomach without tearing itself loose from its connections with the pancreas, liver and transverse colon.

Schrœder, Serres and Lafosse describe cases in which the small intestine was everted into the cæcum and thence through the colon and rectum until it protruded from the anus.

The invagination of the floating small intestine into itself is common at any point, and extensive and even repeated. Marcout records a case in which 24 feet were invaginated, and Rey a case of quadruple invagination at the same point.

The invagination of the cæcum into the colon is frequent, the blind end of the cæcum falling into the body of the same organ, and this continuing to increase until it passes on into the colon, and even carries a portion of the small intestine with it. This lesion is more rare in solipeds because the cæcum has its blind end lowest and gravitation opposes its invagination.

Resulting Lesions. In any case of invagination it must be noted that it is not the intestine alone which slips into its fellow, but it carries with it its attaching mesentery, which, dragging on one side of the invaginated gut, shortens and puckers that and turns its opening against the wall of the enclosing gut so as to block it, while the opposite or free side passes on and tends to form convolutions. If the outer and enveloping intestine is too small to allow of this, the detaining mesentery of the invaginated mass must be torn or stretched unduly and its circulation and innervation correspondingly impaired. When the invagination occurs of one portion of the small intestine into another of nearly equal size, the resulting mass is firm like a stuffed sausage, and this enlargement and consolidation ends abruptly at the point of visible entrance of the smaller contracted portion, into the larger dilated one.

If recent, the invaginated mass is still easily disengaged from the enveloping portion, though considerably congested and dark in color in proportion to the duration of the lesion. When it has been longer confined the incarcerated portion is the seat of extreme congestion, and extravasation, and has a dark red or black color. The exudation into its substance, which is especially abundant in the mucosa and submucosa, produces a thickening which may virtually close the lumen, and on the opposing peritoneal surfaces leads to adhesions which prevent the extraction of the imprisoned mass. The interruption of the circulation and the compression of the invaginated mass, leads soon to necrosis and thus a specially offensive odor is produced, and if the animal survives the whole may be sloughed off and passed with the fæces, the ends of the intussuscepted portion and of that receiving it meanwhile uniting and becoming continuous with each other.

Symptoms. These are the violent colic of obstruction of the bowels, soon complicated by those of enteritis and finally of septic infection.

The animal looks at his flank, paws, kicks with his hind feet, lies down, rolls, sits on his haunches, waves the head from side to side, and sometimes eructates or even vomits. Straining may be violent, with the passage of a few mucus-covered balls only, and rumbling may continue for a time if the small intestines only are involved.

The partial subsidence of the acute pains, the presence of tremors, dullness and stupor, the coldness of the ears and limbs, the small, weak or imperceptible pulsations, the cold sweats, dilated pupils, and loss of intelligence in the expression of the eye and countenance may indicate gangrene, and bespeak an early death which may take place in seven hours.