Part 61

The subsidence of the acute symptoms with improvement in the general appearance and partial recovery of appetite may indicate a spontaneous reduction of the invagination, an issue which may happily arrive in any case in the early stages, but especially in those implicating the cæcum and colon.

An absolutely certain diagnosis is rarely possible, unless the lesion is a protrusion of the rectum, or unless as the disease advances the invaginated part is sloughed off and passed per anum.

Treatment. The failure to make a certain diagnosis usually stands in the way of intelligent treatment. Oleaginous laxatives and mucilaginous gruels are advised to keep the contents liquid, and favor their passage through the narrowed lumen of the invaginated bowel. In cases implicating the floating colon and rectum abundant watery or mucilaginous injections may assist in restoring a bowel which has not been too long displaced. In case of eversion of the rectum, the hand should be inserted into the protruding gut and carried on till it passes through the sphincter ani. Then, by pushing it onward, the arm carries in a portion of the invaginated gut and usually of the outer portion next to the anus as well, and this should be assisted by the other free hand, and even if necessary by those of an assistant, and whatever is passed through the sphincter should be carefully retained, while the arm is withdrawn for a second movement of the same kind, and this should be repeated until the whole protruding mass has been replaced.

Invaginations situated more anteriorly and which can be correctly diagnosed by rectal exploration or otherwise, will sometimes warrant laparotomy, especially those of the cæcum into the colon, where adhesion of the peritoneal surfaces is less common or longer delayed. The patient should be given chloroform or ether, the abdominal walls should be washed and treated with antiseptics, and the incision made back of the sternum and to one side of the median line, and large enough to admit the exploring hand. It has also been suggested to introduce the hand through the inguinal ring, or behind the posterior border of the internal oblique muscle.

INTESTINAL INVAGINATION IN RUMINANTS AND SWINE.

Double colon cannot be invaginated, floating small intestine, cæcum and floating colon can. Causes. Lesions. Symptoms: Acute, violent, persistent colic, palpation of right flank causes gurgling, rectal exploration, prostration, collapse. Duration 1 to 5 weeks. Treatment: Laxative, enemata, injections of sodium bicarbonate and tartaric acid, laparotomy.

In these animals the double colon is rolled around itself between the folds of the great mesentery the free border of which supports the small intestine. The arrangement is as if a piece of rubber tubing were first doubled upon itself, and the end of the loop were then turned inward and the remainder wound round it as a centre. If this were then sewed between two pieces of cloth, the stitches passing between the different windings of the tube at all points, we would have an arrangement fairly representing that of the double colon of ruminants, and, for our present purpose, of swine as well. It must be evident that no portion of a tube arranged in this way can slide into another. It would also appear that the small intestine cannot become invaginated to any extent into another portion or into the cæcum without extreme stretching or laceration of the small portion of mesentery left between it and the coils of the double colon above. The anatomical arrangement is therefore opposed to the formation of invaginations in a way that is not the case in the horse.

Yet invaginations are by no means unknown in these genera. The small intestine can be invaginated into itself or into the cæcum. The cæcum, which floats loose at the right side of the mesentery that envelopes the double colon, can be invaginated into the colon, and the floating colon can be invaginated into the double colon on the one hand and into the rectum and through the anus on the other. Invagination into the rectum, for eight inches, in a bull calf, of six days old, is reported by Cartwright in the Veterinarian for 1829. In a similar case of Youatt’s the intussuscepted portion sloughed off and was discharged per anum.

The causes are like those acting in solipeds, and which give rise to excessive and irregular peristalsis. A drink of ice cold water, indigestions and colics of various kinds, diarrhœa, chills, the irritation caused by poisons or parasites, and the paresis and dilatation of portions of the intestine into which the more active portions can easily pass. Almost any irritation or congestion may cause intussusception, and young animals in which peristalsis is most energetic are the most liable.

Lesions. The intussusception is usually found in the ileum and to a less extent in other parts of the small intestine, or involving the cæcum and colon, or again the floating colon and rectum. The successive conditions of congestion, exudation, adhesion, obstruction, necrosis, sloughing, and repair by union of the remaining ends are the same as in the horse.

Symptoms. There is acute, agonizing and dangerous colic in an animal in which these troubles are usually comparatively slight and transient. The animal looks at the right flank, paws or stamps with fore feet as well as hind, lies down and rises often, strains to pass manure but passes only mucus or a few small hard masses, if anything. If pressure is made on the right side of the abdomen and the hand suddenly withdrawn there is a significant gurgling and the corresponding hind foot is lifted or moved forward or backward, appetite and rumination are lost, the pulse becomes rapid and weak, and the animal becomes prostrate, dull and stupid, often remaining recumbent in spite of all efforts to raise him. Rectal exploration may detect the firm tender mass in the seat of the invagination. The disease may last from one week to five, according as the obstruction is complete or partial. The usual termination is a fatal one, though a certain number of spontaneous recoveries are met with.

Treatment. By a happy accident the peristalsis or anti-peristalsis determined by a purgative will sometimes disengage the intussuscepted bowel. Copious injections into the rectum may also prove useful in case of intussusception of the floating colon or rectum. Or the disengagement of carbon dioxide from the injection of solutions of sodium bicarbonate and tartaric acid may be tried. Laparotomy is however the most radical measure when a certain diagnosis has been made and this is less dangerous in the cow than in the horse in which peritonitis is so grave. Under antiseptic precautions an incision is made in the right flank and the invagination found and reduced. In case firm adhesions have already taken place, and above all if the included gut is apparently gangrenous, the latter may be exposed by breaking down the connections at the side opposite to the attachment of the mesentery, or where the adhesions are least firm, then cutting out and removing the incarcerated gut and carefully closing the opening between the ends by suture. The use of a sublimate or carbolic acid solution and careful suturing and bandaging of the external wound with carbolated cotton wool will often give a successful issue.

INTESTINAL INVAGINATION IN DOGS AND CATS.

Anatomical conditions favor. Causes: as in other animals, common in icterus, and surgical operations from deranged peristalsis. Lesions: most common in small intestines, congestion, inflammation, necrosis, sloughing. Symptoms: may be colic, but not always, dullness, anorexia, vomiting, constipation, palpation, swelling firmer than from impacted twine. Treatment: shot, castor oil and exercise on hind legs. Demulcents. Laparotomy.

The intestines of the carnivora are more open to invagination than in other domestic animals for even the colon is free enough throughout its course to allow of one part sliding into another. The causes to which it is attributed are in kind the same as in other domestic animals. The swallowing of ice cold water in excess when heated, diarrhœa, superpurgation, intestinal worms, the active peristalsis of early life, and jaundice have been especially blamed. Reynal found intussusception twenty times in forty cases of icterus and Rancilla four times in five cases. It has been frequently seen after severe surgical operations, and it is surmised that in both cases alike the deranged peristalsis attendant on severe suffering was the cause of the accident.

Seat and Lesions. The most common seat of invagination is in the small intestines, and less so in the cæcum and colon, or rectum. The lesions are as in the other animals, congestion, infiltration, adhesion, necrosis, gangrene and sloughing.

Symptoms. There may be colics as in the larger animals, but in some instances there are simply prostration, dullness, inappetence, vomiting, constipation, or the passage of a little liquid and fœtid excrement. Palpation of the abdomen detects a firm, cylindroid and very tender swelling on the line of the softer intestine which taken with the other symptoms is nearly pathognomonic. If situated in the small intestine and disconnected from the rectum and pelvis the diagnosis is more satisfactory. Impaction is most commonly in the rectum and floating colon and can be traced into the pelvis and even felt by the finger introduced into the anus. It might be confounded with obstruction of the intestine by the ingestion of twine, but the swelling is usually firmer and the cylindroid outline more uniform in intussusception.

Treatment. The measures recommended for the larger animals are applicable to the dog. Cadeac has had four recoveries in seven cases after the use of leaden shot and castor oil. Three balls of No. 16 calibre are dipped in castor oil and given to the dog. This is followed by ½ oz. of castor oil slightly heated, and walking or running exercise, or take the dog by his fore limbs and walk him around on his hind. No drink is allowed for 24 hours, and a quart of decoction of flax seed on the day following.

Should these measures fail, laparotomy is available, yet it is more promising in proportion as it is resorted to early, before ulceration, or gangrene has set in. The manipulations are practically the same as in the ox and the outcome is even more promising. The diet should be restricted to milk or mucilaginous gruels for a week after the operation.

VOLVULUS (TWISTING) OF THE INTESTINE IN SOLIPEDS.

Definition: rolling of a loop on its mesenteric axis, bending in a vicious direction, rolling of one loop round another. Causes: laxity of mesentery in hernia, relaxation or rupture of linea alba, pot belly in old breeding mares, sudden movements in falls, leaps, draught, galop, slipping, mounting, warm weather, casting, rolling, rising, sudden filling of a loop, heavy feeding and fermentescible food, cold drinks, chills. Lesions, most in double colon, next in jejunum, cæcum wrapped in small intestine, floating colon, tympany and pallor of obstructed loops, later congestion, infiltration, extravasation, adhesions, necrosis, sloughs, infective peritonitis. Symptoms: sudden severe attack, violent, reckless colicy movements, pain constant with exacerbations, fever, prostration, collapse. Diagnosis: only by rectal exploration and exceptionally. Treatment: by rectal manipulation, eserine, castor oil, laparotomy.

Strictly speaking this lesion consists in the twisting of a loop of intestine upon its mesenteric axis, so that the portion which is drawn spirally over the mesentery of the other is more or less completely obstructed. The term has, however, been applied as well to the turning of a viscus at a sharp angle from its normal direction so as to interfere more or less with the passage of its contents and with its circulation. This has been especially seen in a vicious direction given to the cæcum, but also at times to the double colon. The simple twisting on the mesenteric axis is common to the floating portion of the small intestines, the double colon, floating colon and rectum. A third form of twisting which is, however, rather a strangulation, consists in the rolling of one loop of intestine round the loop of another, the mesentery of which has become unduly long.

Causes. The predisposing cause is a certain laxity or undue lengthening of the mesenteric attachment of the intestine. This is sometimes formed in connection with the existence of hernia, into which the bowel protrudes, or short of this a relaxation or rupture of the linea alba so that the whole of the intestinal mass hangs down unduly, or finally in unthrifty pot-bellied animals and in breeding mares in which the abdomen is unduly pendent.

Next comes the question of sudden movement as in falls, in leaping, in violent exertions of draught, or galop, in sudden slipping upon wet or icy ground, and of stallions in mounting mares. In the Omnibus Company’s (Paris) horses Palat found 35 cases in entire horses, 23 in mares, and 11 in geldings. The stallions in the stables were fewer than the mares and geldings put together, but it does not appear that the difference was sufficient to make the above figures very significant. These stallions it should be added, are not used for breeding, so that the statistics have no bearing on the effect of mounting.

Palat’s figures show a greater number of cases in summer, than in winter. There were 58 cases from April to October and but 21 from November to March. It would seem as if the relaxation of the system and mesentery in summer more than counterbalanced the combined effect of slipping on ice and sudden chills.

A large proportion of the cases have been found in horses that have died of colic, or which have been cast for operation, and the recent character of the lesions has often shown that we must look upon them as the result of the tumultuous peristalsis, and the lying, rolling, sitting and other sudden and unwonted movements performed. A heavily loaded portion of bowel, occupying a position slightly lower than a lighter portion or parallel to it, suddenly moves by gravitation when their relative positions are altered as in rolling, decubitus, or rising, and it thereby becomes twisted upon itself. Or a portion of intestine filled with liquid or gaseous contents is suddenly emptied by the passage of these onward into another and the latter portion of intestine or some other lodged alongside it, in moving to fill the place, rotates upon itself and establishes a volvulus.

Hard worked horses which are subjected to stimulating feeding are much more frequently attacked than those which have light work and feeding. In the same way newly harvested hay or oats, spoiled or otherwise indigestible food have apparently been productive causes. Cold drinks, and exposure to cold draughts have been similarly charged. Indeed any cause of indigestion and colic may be held to predispose to volvulus.

Lesions. Seat. Twisting of the small intestine is impossible in the duodenum, and for the floating portion it is far more common in the ileum and terminal portion of the jejunum where the mesentery is long than in the anterior jejunum where it is short.