Part 62

The double colon from the sternal portion to the pelvic flexure being free from any restraint by omental or mesenteric bands is especially liable to torsion. Palat found four cases of torsion of the colon to one of the small intestine, and Schutze gives the ratio as 56 of the first to 13 of the second.

The cæcum has been frequently found twisted upon itself with a portion of the small intestine rolled round it.

The floating colon like the small intestine is rolled around its mesenteric axis, but cases are much more rare than in the case of the small intestine.

In a recent and complete twisting with obstruction of the bowel, the loop of intestine is distended with gas the result of fermentation of its contents, and its walls may be thin and pale. Much more commonly and when the lesion is of longer standing there is hyperæmia, and infiltration and thickening with inflammatory products, and blood extravasations. At the seat of torsion the compressed intestine is congested, covered with petechiæ, and its peritoneal surface with fibrinous exudate tending to bind the parts together. Later there may be seen spots of necrosis and perforating sores and semi-detached sloughs, or the whole mass of twisted bowel may be gangrenous. The patient usually dies before this last stage has been reached. If the animal survives long enough the lesions of infective peritonitis are constantly present.

Symptoms. The disease usually sets in suddenly with intense severity. In exceptional cases there is an insidious onset, the twist being at first but partial and gradually increasing and for a time the contents pass on in a restricted but still physiological manner. Colics at first slight become by degrees more and more intense until all the symptoms of obstruction and acute inflammation are developed.

More commonly symptoms of extreme gravity appear at once, the patient stops, paws, kicks at his belly, tries to lie down, strains to defecate or urinate, lies down, rolls, sits, gets up and moves round uneasily trying to lie down again. He looks at the flank with anxious eye and countenance and has all indications of the most violent colic. Pain is constant, but worse at one time than another, the pulse is from 50 to 90 and becomes weak and even imperceptible as the case advances, and hyperthermia, at first slight or absent rises with the onset of inflammation. Finally great prostration, depression and stupor, sunken, glazed eye with dilated pupil, and cold sweats and extremities bespeak collapse or general infection.

Diagnosis is rarely certain. The sudden onset, extreme violence of the symptoms, and rapidly fatal progress are significant and in exceptional cases rectal exploration will detect obstruction in the rectum or floating colon, or a tympanitic condition of the pelvic flexure.

Treatment. A rational treatment is only possible in those rare cases in which the diagnosis is certain. When the lesion can be reached in the rectum or adjacent part of the floating colon, the oiled hand may be made to drag on the interior of the viscus so as to restore it to its normal position.

Cadiot has had recoveries from supposed volvulus by the use of eserine hypodermically, and Trasbot by the use of castor oil and it is just possible that active peristalsis, and plenitude of the bowel running into the volvulus, may serve to unwind slight cases. When the diagnosis is certain and the case, as usual, intractable the resort of laparotomy and the attempt at untwisting is fully warranted. The case is a fatal one if unrelieved.

VOLVULUS IN RUMINANTS.

This condition is almost unknown in ruminants, Reichert recording a single case of volvulus of the ileum involving 8 inches of the gut. The reason for the habitual immunity is to be found in the arrangement of the small intestine at the end of a mesentery which is strengthened and stiffened by the winding folds of the colon until twisting is practically impossible. There remains, therefore, only the floating colon and rectum at all exposed to the lesion. The isolated case of Reichert only proves the rule.

VOLVULUS IN DOGS.

Rare. Short mesentery hinders. Occurs with hernia. Symptoms: obstruction, prostration, colic, tense, painful abdomen, retching, anorexia, exhaustion. Treatment: laparotomy.

The carnivora seem to be protected against volvulus by the shortness of their mesentery, the comparative lightness of the intestinal contents, and the restricted area of the abdominal cavity. Cadiot, Müller, and Friedberger and Fröhner agree in ignoring the subject as a canine disease, while Cadeac mentions only such cases as are complicated by mesenteric hernia, the protruding loop becoming twisted in the wound through which it has protruded.

“The symptoms are those of invagination or intestinal obstruction; sometimes the animal is dull, anxious, resting almost constantly down on his belly, and this prostration dominates the table of symptoms; sometimes, on the contrary, the subject manifests signs of excitement and intestinal pain; it trembles, lies down, glances at its flanks; sometimes it even lets itself fall abruptly, straightens out stiffly its limbs and head, clenches its jaws and rolls its eyes.”

“In all cases the belly is hard, drawn up, painful to pressure or palpation; but these means of exploration are insufficient to feel the intestinal knot.”

“Constipation is persistent, obstinate, and efforts at vomiting continuous; anorexia is incomplete, or the animal rejects the solid and liquid aliments immediately after their ingestion. Vomited matters, when they exist, become glairy, bilious toward the end of the attack; but sometimes the animal becomes exhausted in his fruitless efforts; one is rendered uncertain and hesitates to confirm his diagnosis by laparotomy.”

The only treatment advised is by laparotomy.

INTESTINAL STRANGULATIONS BY ADVENTITIOUS BANDS.

Result of circumscribed peritonitis. Extends from one part of abdominal wall to another, around or between intestines, on omentum, or adhesion of omentum to inguinal ring. In cattle tubercular products strangulate bowels. Symptoms: the colic of obstruction, rectal exploration. Treatment: laparotomy, removal of constricting band.

Adventitious fibrous bands in the abdomen are the result of a pre-existing peritonitis of a circumscribed area. The fibrinous exudate thrown out on the parietal peritoneum is detached in its median part but remains adherent at the ends, and when organized into tense resistant white fibrous tissue remains as a trap to entangle and strangulate the intestinal folds. In other cases they form on or between intestines or other viscera which are for the moment torpid and inactive, and contracting as they become organized, they bind these together and hamper their movements, and endanger the integrity of all movable viscera in the vicinity. Again they form on the omentum and threaten the integrity of the bowels by strangulation. The omentum protruding at castration becomes adherent to the inguinal ring and forms a dangerous band.

In cattle the growth of peritoneal tubercle often binds the small intestines together in an inextricable tangle leading to considerable compression, and obstruction without a complete stenosis.

Symptoms. These vary with the organ constricted, but they are usually those of a more or less perfect obstruction of some portion of the intestine small or large, which has passed over or under the constricting band and fails to return, often undergoing a torsion which renders its imprisonment still more secure. The author has found the double colon fatally constricted in this way, and Leblanc furnishes a similar case. Cases are on record of the binding of the duodenum to the right lobe of the liver by a strong fibrous band, of the binding of the double colon to the right flank and in another case to the floor of the abdomen, and of the ileum to the meso-rectum and in another case to the left flank. These give rise sooner or later to obstruction of these viscera or, to incarceration of adjacent ones so that the animal dies of intestinal obstruction with its attendant symptoms.

Treatment. If the true nature of the case can be made out by rectal exploration the appropriate treatment is by laparotomy and the removal of the constricting band.

PELVIC HERNIA IN THE OX. GUT TIE.

Cause: laceration of parietal peritoneum by tearing through the spermatic artery, a loop of intestine is strangulated in the resulting pouch. Diagnosis: patient is a steer castrated by the method named, rectal exploration confirms. Treatment: turn on back, jump from a height, trot down hill, dislodge incarcerated mass by hand in rectum, pass cannula through rectum, introduce probpointed bistoury and cut through the band, or laparotomy. Second Form: adhesion of stump of spermatic cord to intestine, or abdominal wall or formation of a pediculated tumor, and resulting strangulation of intestine. Third Form: weight of testicles tears the peritoneum from the abdominal wall forming pouch. Treatment: laparotomy.

Causes. This is a peculiar affection said to be connected with a faulty mode of castration in calves. When the testicle has been exposed, the spermatic cord is torn through by sheer force, or the posterior portion having been cut across the anterior division is dragged upon violently until torn apart. The gelders usually estimate the quality of the operation by the length of the artery which can be torn out. The artery which is the most resistant portion of the cord and the last to give way takes its origin from the posterior aorta opposite the posterior mesenteric artery, extends outward by a curvilinear course just in front of the brim of the pelvis, and when stretched violently it is straightened out and carries with it the peritoneum, tearing it from the portion immediately in front and forming a sac, or tearing it completely apart from the abdominal wall in its median part and leaving it attached above and below. Into this sac, or above this band, which is just below the sacral transverse processes, a loop of intestine may pass, and becoming strangled there, produces all the symptoms of intestinal obstruction.

Diagnosis is helped by the fact that the animal is a steer, and in a locality where the above-named mode of castration is in vogue. It is completed by feeling the imprisoned intestine and the constricting cord just under the right or left transverse processes of the sacrum.