both were therefore decompressed by suction enterotomy, with successful results. On the basis of only 2 cases, it is too early to advocate this method in the treatment of resistant paralytic ileus, but it certainly has possibilities.
Of the mechanical obstructions, it was the rule for normal peristalsis to be resumed within 48 hours. All surgeons will recall many anxious post-operative hours in long-standing low small-bowel obstruction treated without operative decompression. Because of the very high survival-rate and the paucity of post-operative complications, the series quoted above can only be a significant recommendation for the routine use of operative decompression where gross distension is encountered.
SUMMARY I .
Distension continues to be one of the main factors contributing to the high mortality and morbidity rate in small intestinal obstruction.
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T h e long intestinal tube is a valuable device, but is not a substitute for operation. Furthermore, the difficulty often experienced in successfully passing such a tube is exhausting to an ill patient, and its use in the advanced case is therefore not recommended.
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Early operation is urged in non-strangulating mechanical low small-bowel obstruction after a preliminary restoration of fluid and electrolyte balance.
The desirability of surgical decompression of the distended intestine is discussed.
- An instrument has been described and a technique evolved which are ideal for the purpose.