Studies on high intestinal obstruction: The administration of saline and other substances by enterostomy below the site of obstruction
✍ Scribed by J. C. Armour; T. G. Brown; D. M. Dunlop; T. C. Mitchell; H. H. Searls; C. P. Stewart
- Publisher
- John Wiley and Sons
- Year
- 1931
- Tongue
- English
- Weight
- 819 KB
- Volume
- 18
- Category
- Article
- ISSN
- 0007-1323
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✦ Synopsis
THIS investigation was undertaken in an attempt to determine the cause of death in high intestinal obstruction, and t o elaborate if possible a means of preventing death after the establishment of the condition. At the outset it is to be emphasized that the study was confined to simple high obstruction, the questions-entirely distinct, as we believe-of strangulation and 'closed loops' not being considered.
Opinion as to the cause of death in high intestinal obstruction is more or less sharply divided. The oldest theory is that death is due to the absorption of some toxic substance formed above the site of the obstruction. The origin of this hypothetical toxin has been the subject of much discussion. There are many who attribute it to bacterial putrefaction of the intestinal contents above the obstruction, where, indeed, both aerobic and anaerobic organisms may be present in large numbers. In particular, attention has been drawn to the possible importance of B. zvelchii in the production of symptoms in intestinal obstruction by the work of Wi1liams.l Struck by the clinical resemblance of some of the symptoms of obstruction to those of gas gangrene, he began to investigate, both qualitatively and quantitatively, the occurrence of B. zerelchii in the contents of the obstructed intestine, and to administer antitoxin as a therapeutic measure. As a result of combined experimental work and clinical study he finally suggested that the absorption of B. zerelchii toxin was, in part at least, responsible for the symptoms of obstruction. He also brought forward evidence to show that the proliferation of B. zvelchii and the presence of its toxin could apparently be demonstrated in the human subject and in dogs. The therapeutic use of anti-gas-gangrene serum showed, in Williams's cases, a fall in the mortality-rate from 24.8 per cent to 9.3 per cent. His work excited considerable interest, and serum has been extensively used in the treatment of cases of acute intestinal obstruction.
-4ccording to Whipple,2 however, a toxic proteose is formed in the intestinal mucous membrane itself, part being excreted into the lumen and part passing into the circulation. It is difficult, however, to explain along these lines or along any lines involving the production of a toxin the fact that death follows an obstruction just below the pylorus with great rapidity,