Gastro-Intestinal Obstructions

Abstract

A REVIEW of the recent literature dealing with gastro-intestinal obstructions, especially those of the acute form, reveals two amazing facts: (1) Notwithstanding the great progress made in the advancement of our knowledge of clinical observation, physical examinations, and the introduction of new methods, such as the X-ray, the mortality of acute intestinal obstruction still remains high; (2) in spite of the constant use of the X-ray in the examinations of the gastro-intestinal tract physicians and surgeons appear to have very little knowledge of its usefulness in the diagnosis of acute obstructions. C. J. Miller, of New Orleans (1), found that in 343 cases of intestinal obstructions, 209 patients died, a gross mortality of 60.9 per cent. A. H. Burgess, of London (2), found that in 1,042 cases of intestinal obstructions studied by him, 395 patients died, a gross mortality of 37.9 per cent. J. P. North, of Philadelphia (3), collected the mortality statistics from a series in the literature totalling 1,625 cases of intestinal obstructions, including 200 patients of his own, of whom 425 died, a gross mortality of 29.2 per cent. W. F. Cheney, of San Francisco (4), in his monograph greatly deplores the high mortality in acute intestinal obstructions. All of these writers give the same reason for the high mortality, namely, failure to make an early diagnosis and delay of surgical intervention. No one, with the exception of Dr. Miller, mentions anything about the use of the X-ray in the diagnosis of acute intestinal obstruction, and he does so only to contra-indicate its use. It is quite evident, therefore, that the rank and file among physicians and surgeons know still less of the use of the X-ray in acute intestinal obstructions. In contrast with the lack of knowledge on the part of physicians and surgeons, let us see what radiologists have to say on this subject. Dr. James T. Case (5), as long ago as 1915, has the following to say: “Acute intestinal obstruction is a condition in which, until now, the X-ray has not been regarded as a means of diagnosis. During the past five years, however, the writer has seen a number of cases of acute small intestine obstruction in which the X-ray gave advance information of a decisive character before it was possible by other clinical means to make a definite diagnosis of small intestine obstruction.” He also tells us how to recognize it. “It is not necessary to administer bismuth for this purpose. The characteristic reticulated appearance of the shadow cast by the gas-distended small bowel in cases of acute obstruction is pathognomonic and no bismuth is necessary.” Since then, Dr. Case has written several other papers dealing with the same subject. Other radiologists have from time to time emphasized the importance of the use of the X-ray in acute intestinal obstruction, and yet the medical profession at large remains ignorant of its true value.