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Related post: true hernial sac. The diagnosis has been rarely made.
Under the term volvulus are included only those cases
in which a loop of intestine, free of all adhesions, is twisted
upon itself or is strangulated at its base by another loop
which encircles it. The form most frequently met with,
Feb. 25, 1888.
STLMSON: INTESTINAL OBSTRUCTION.
207
two thirds of all cases of volvulus, is simple twisting; of the
sigmoid flexure; and in the form in which two loops take
part, the sigmoid flexure is usually one of them. Esomeprazole Online The con-
dition is of infrequent occurrence, between 4 and 5 per
cent, of collected cases, and volvulus of the sigmoid flexure
is rarely encountered under the age of forty years. In vol-
vulus of the sigmoid flexure the upper end of the loop usu-
ally passes in front of the lower one at the point where the
latter is continuous with the rectum, and if only a half-turn
is made (180°), the constriction may involve only the lower
end. This was the condition in the only case I have seen,
and the flexure, as is usual, was greatly distended, Purchase Esomeprazole to a di-
ameter of more than four inches. It has been observed in
autopsies that the twist has a marked tendency to recur
Avhon air is forced into the loop from the upper segment of'
the bowel, and it may therefore be doubted whether the
simple liberation of the loop by untwisting it after lapa-
rotomy would effect a stable cure ; possibly the establish-
ment of an artificial anus in the loin would be necessary.
Sharp changes in the direction of the intestine, by which
the wall becomes kinked and the lumen obliterated, are the
result of adhesions ; since the performance of laparotomy
has become so common, the instances of obstruction due to
this cause have multiplied.
In intussusception or invagination a segment of the
bowel becomes turned into the one below it, and this engaged
portion, the intussusceptnm, is forced along by the peri-
staltic action of the portion within which it lies, and in this
progress the upper part of the latter is also rolled in, pari
passu. In about half of the cases the process begins at the
ileo-c;ecal junction, and the head of the intussusceptnm,
recognizable by the ileo-csecal valve and the orifice of the
appendix vermiformis, may appear at the anus. It is the
most frequent of all the causes of obstruction, and is Order Esomeprazole Online esti-
mated by Treves to constitute three eighths of all cases.
Half of all its cases occur, according to Leichtenstern, during
the first ten years of life, Purchase Esomeprazole Online and half of these, one fourth of
all, durinsj the first year. It diflPers markedly from the
forms previously mentioned by being capable of spontaneous
relief or of relief by injection, and in presenting a chronic
as well as an acute variety. The hyperacute cases, those
in which death follows within the first twenty-four hours,
are very rare, less than 1 per cent. ; the chronic, those in
which the condition has persisted for a month or more, con-
stitute 18 per cent. ; the acute and the subacute, 48 and 34
per cent., respectively (Treves). In fully half of the acute
and subacute cases a characteristic tumor can be felt in the
abdomen, and in the great majority of these cases the symp-
toms are such that a diagnosis can be readily made ; the
great difficulty is in the recognition of the chronic cases.
At the beginning the constipation is often incomplete,
vomiting infrequent, pain moderate, and the abdomen soft
and not distended or tender. As soon as the occlusion be-
comes complete, bloody mucus is discharged in the stools,
and the signs of peritonitis appear. The mortality of all
cases is VO per cent., the highest rates being in acute cases
in young children Generic Esomeprazole and in the chronic cases; of 59 of the
latter collected by Raffinesque, 51 ended fatally. Of 249
fatal cases collected by Leichtenstern in which the ages
were noted, 100 were in children less than one year old, and
48 in children from one to ten years old.
Obstruction of the bowel by the pressure of a tumor or
displaced viscus may be acute or chronic, and the predomi-
nance of the former in reported cases is doubtless due to
the fact that the latter, being less striking and important,
are not usually reported. The occlusion is effected by com-
pression of the bowel between the wall of the abdomen
(usually the pelvis) and the compressing body, the latter
being most commonly a tumor, as a fibroid of the uterus or
an ovarian cyst. Among the less frequent causes are ab-
scesses, tubal pregnancy, displaced spleen or kidney, hy-
datid cysts, and even a vesical calculus. Of 165 cases col-
lected by Leichtenstern, the rectum was compressed in 60
per cent.j the sigmoid flexure and descending colon in 12
per cent., the lower part of the ileum in 10 per cent., and
the duodenum in 7 per cent. The compression of the ileum
and of the sigmoid flexure in most cases appears to have

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