Intussusception

“ While intussusception may occur in either sex and at all periods of life, it happens nearly twice as often in males as in females, and is most frequently seen in childhood. Leichtenstern6 found in his statistics of 473 cases that one-half were seen in children under ten years old, and one-fourth of all intussusceptions occurred in children from four to twelve months old. Invagination of the small intestine is found almost exclusively in adults. ”

“ The invaginated portion is termed the intussusceptum, and the lower portion which it enters is known as the intussuscipiens. It is to the constriction of the vessels in the entering mesentery and later to their possible complete obstruction that are due the late serious phenomena of intussusception, e.g. gangrene or rupture of the gut. ”

“ Intussusception.— Intussusception is also an occasional occurrence, especially in children. It is not always readily recognized. A sudden increase of pain, increased straining, entire absence of fæcal matter from the stools, vomiting, and perhaps the presence of a tumour in the rectum, might lead one to suspect and examine for this accident.
Tenderness; thickening.— The abdomen is tender in most cases of acute dysentery. If the disease be of some standing a certain amount of thickening may be felt along the track of the colon, particularly over the sigmoid flexure. ”

“ Intussusception may be acute or chronic, sometimes lasting intermittently for years. The acute form is the most common. In young children an attack occurs with severe pain, at first paroxysmal but later continuous ”

“ The subluxation interfering with the transmission of mental impulses causing intussusception will be found in the lumbar region, the specific vertebra depending upon the location of the intussusception, whether in the upper or lower intestinal tract. Most excellent results have been obtained in these cases, and there should be no hesitancy in adjusting. The function involved is motor, which prevents a coördinate action of the muscular walls of the intestines. As soon as this action becomes normal Innate Intelligence will correct the condition and all symptoms will subside. ”

“ The Secondary and Commonplace Character of the Process of Intussusception.—The apparent opposition of these two processes is doubtless diminished if we compare the simple mineral individual with the elementary living unit, the crystalline particle with the protoplasmic mass of a cell. Without carrying analysis so far as this, it is yet easy to see that apposition and intussusception are mechanical means that living beings employ at one and the same time and combine according to their necessities. ”

“ The convex side of the middle cylinder is often thrown into transverse folds or convolutions. Intussusception, which gives rise to symptoms characteristic of intestinal obstruction during life, is invariably from above downward. It is doubtful whether there is on record a single well-authenticated case of inflammatory invagination where the lower segment of bowel protruded into the upper. ”

“ That intestinal obstruction is not always complete in intussusception is shown by the fact that fecal matter, often in considerable quantity, is passed through the bent and narrowed tube, the intestine retaining, at least for a time, its contractile power. The changes produced by inflammation are chiefly seen in the inner and middle layers of intestine, the receiving or outer layer of the invagination often escaping any serious damage. These changes vary with the character and duration of the inflammation. ”

“ The woman recovered, but died five months later from a second attack of intussusception, the ileum rupturing and peritonitis ensuing. There is a record in this country of a woman of forty-five who discharged 44 inches of intestine, and who survived for forty-two days. The autopsy showed the sigmoid flexure gone, and from the caput ceci to the termination the colon only measured 14 inches. Vater gives a history of a penetrating abdominal wound in which a portion of the colon hung from the wound during fourteen years, forming an artificial anus. ”

“ In all cases, the process of evolution consists in a succession of changes of the form, structure, and functions of the germ, by which it passes, step by step, from an extreme simplicity, or relative homogeneity, of visible structure, to a greater or less degree of complexity or heterogeneity; and the course of progressive differentiation is usually accompanied by growth, which is effected by intussusception. This intussusception, however, is a very different process from that imagined either by Buffon, or by Bonnet. ”

“ In intestinal obstruction from intussusception or from strangulated hernia, for instance, it is best to advise the calling of a surgeon immediately, while in obstruction from volvulus or intestinal paralysis the adjustments may afford relief and should at least be tried first of all.
Any internal abscess presents a possibility of rupture into a serous cavity or the substance of a parenchymatous organ and is therefore dangerous, while a superficial abscess, pointing toward the surface, can best be cared for by adjustment. ”

“ There are no symptoms positively diagnostic. Colicky pains, more or less severe and continuous, are observed, and at first there may be diarrhea, followed by constipation. Severe straining occurs in some instances of intussusception, and when this occurs it should receive due credit. As death approaches, the horse sweats profusely, sighs, presents an anxious countenance, the legs and ears become cold, and there is often freedom from pain immediately before death. ”

“ Vomiting succeeds, but is not persistent; discharge of the contents of the bowel below the seat of lesion takes place and afterward fecal matter from above this point, because the permeability of the bowel is not usually lost in chronic cases. Eventually the alvine discharges become bloody, mucoid, and characteristic of intussusception; the severity of the symptoms may gradually increase, the pain becoming greater, more constant, the vomiting more incessant, the discharges from the bowels more frequent, and in one, two, or three months the patient dies from asthenia. ”

“ In volvulus involving the sigmoid flexure, when injury to the bowel is great, the symptoms are acute in the extreme. After peritonitis or enteritis begins, progress toward a fatal issue is very rapid, the patient rarely living more than three or four days. In occlusion from stricture, compression, fecal impaction, and chronic intussusception the patient may live for weeks or even months.
The statistics of Leichtenstern show that from 5 to 10 fatal cases of intestinal obstruction occur every year among every 100,000 inhabitants ”

“ The small intestines make two principal convolutions, and are kept in their place by a well-developed mesentery. I could detect no trace of a pancreas. As the intestine approaches the rectum, it becomes excessively narrow, and at last ends almost by intussusception (Fig. 5) ; the wide and capacious rectum ends in the cloaca. Before examining the internal structure of these parts, it may be well to compare them with similar organs occurring in the salamanders. For this purpose I have selected Triton cristatus and Salamander maculosa. ”

“ The prevalence of an epidemic of the disease will often establish the character of a case even when all the signs are not present or when anomalies occur. Embarrassment in diagnosis only attends the recognition of catarrhal or isolated cases, and in these cases there may be a doubt as between dysentery and [p. 807] diarrhoea—if such a symptom can be called a disease—or typhoid fever, cholera, or some purely local affection of the rectum, cancer, hemorrhoids, etc. In children difficulty of diagnosis may arise as between dysentery and intussusception. ”

“ The phenomenon of vicarious excretion may occur through the kidneys, lungs, skin, throat, nose, vagina, or uterus, thus keeping up chronic diseases and discharges that would not exist but for the chronic constipation or even for incomplete action of the bowels each day. Over-distention of the rectum, sigmoid and colon, due to the pressure of gases and the impaction of feces, results in inflammation, ulceration, stricture, appendicitis, abscess, strangulation, intussusception, and abnormal ballooning or roominess in certain portions of these intestines or conduits. ”

“ Supplementary causes.— It is conceivable that in a highly predisposed liver exciting causes other than dysentery, such as a blow or sudden aggravation of chronic congestion by chill or excess, may suffice at times to determine suppuration. Liver abscess is most prone to develop at the commencement of the cold season. Further, one can conceive that in a hyperæmic liver struggling to resist dysenteric suppurative influences some third condition, such as the blow, chill, or surfeit referred to, may contribute to or determine the formation of abscess which, in its absence, might have been averted. ”

“ These abscesses are not always situated in the ischio-rectal fossa; frequently they are subcutaneous and just outside the anus: in other cases the starting-point may be ulceration of the mucous membrane of the rectum, with escape of fecal matter into the areolar tissue; they also originate in the submucous connective tissue of the rectum. The acute abscess is sudden and very severe in its onset; the pain is continuous, throbbing, and augmented during defecation; dysuria is almost always present, and in some cases there is total inability to pass water. ”

“ This kind of abscess, though not itself dangerous, has given opportunity for the inoculation of venereal matter in the hands of accoucheurs, and of putrid matter from the dissection of diseased bodies; and has thus been the cause of disease and death. When putrid matter has been thus absorbed from a dead body, a livid line from the finger to the swelled gland in the axilla is said to be visible; which shews the inflammation of the absorbent vessel along its whole course to the lymphatic gland; and death has generally been the consequence. ”

“ Bilharziasis of the rectum is manifested by symptoms of dysentery; the repeated violent attempts at defæcation lead in time to prolapse of the rectum, which sooner or later induces septic infection and so death. In the mucosa of the rectum, polypoid growths similar to those in the bladder are met with, due to the ova of the parasites in the mucosa and submucosa. In the case of a man, aged 36, who had lived for a long time in South Africa, Burfield487 found in the excised vermiform appendix ova of Schistosoma hæmatobium ”

“ From the united labors of Professors Zenker and Heller it is now rendered certain that all the further changes necessary to bring the larvæ to sexual maturity are accomplished within the small intestines of the human bearer; and it is not necessary that a change of hosts should occur at any time during the life of the parasite. Infection ordinarily takes place by the accidental and direct conveyance of the eggs that are lodged in the neighbourhood of the victim’s anus to the mouth. ”

“ Pus may be thrown off by a mucous membrane, without any actual breach of continuity. Diffuse infiltration of the tissues is the most dangerous form of suppuration.
In this variety of inflammation the exudate is brought into contact with the greatest possible extent of absorbent vessels, for as a surface of a sponge is greater than that of a bag, which would contain it, so the surface of these intercellular spaces is much greater than that of an abscess cavity filled by the same amount of pus. ”

“ The parasite may be found in its adult state within the lumen of the cæcum or colon, but it is found more frequently in the larval stage lodged beneath the mucous membrane in cysts varying in size from that of a pin's head to that of a hazel-nut, each cyst containing a coiled-up worm. The species peculiar to apes and monkeys are likewise found during their larval stage within small hæmorrhagic cysts beneath the mucosa of the cæcum and large intestine. The parasites are blood-suckers; their intestines are crammed with erythrocytes. ”

“ In conclusion, his study identifies two neural elements essential for the cold-seeking response of rats to bacterial LPS: neuronal bodies located in the DMH and axons passing through the PVH. These are the first two landmarks on the map of the circuitry of cold-seeking behavior associated with endotoxin shock.
Methods Animals Experiments were performed in adult male Wistar rats (Harlan, Indianapolis, IN, USA) . At the time of the electrolytic or excitotoxic lesioning, the rats had a body mass of 370–400 g. ”

“ When they find their way into the parietes of the abdomen and adjacent parts, they usually give rise to the formation of abscesses requiring surgical interference.
As regards the symptoms produced by lumbrici, these vary according to the situation they happen to occupy. The symptoms are also modified by age and temperament. In the stomach and intestines they give rise to colic and shooting pains about the abdomen, followed generally by dyspepsia, nasal itching, nausea, vomiting, and even diarrhœa. Occasionally death supervenes suddenly. ”

“ Active inflammatory action may, however, be excited at any time, as in other chronic abscess, by a new infection, septic organisms entering the abscess by way of the uterine cavity, an adherent loop of intestine, or the bladder. The woman will then have an attack of acute septic inflammation in the old pyosalpinx, and will be exposed to the various dangers that were imminent during the primary acute stages of the disease. ”