The roentgen-ray diagnosis of acute intestinal obstruction

Abstract

‘EXT to appendicit,is, intestinal obstruction is the most common emergency encountered on the He laid especial emphasis on the vaIue of this procedure in recognizing postoperative ileus requiring reoperation. Since that time he has pubhshed several reports of further observations on the same subject, his most recent report? incIuding a review of the Iiterature which indicated that the method was being adopted at other cIinics, and was pro\-ing itseIf to be a vaIuabIe diagnostic aid in dealing with this common abdomina1 emergency. general surg;caI service of the Los AngeIes County General Hospital. The mortality is between 40 and 50 per cent, which is consistent with the statistics of other similar institutions. This very high mortality is particuIarIy unfortunate when we reaIize that the pathology in most cases of intestina1 obstruction can be corrected by relativeI simpIe surgica1 procedure, and if the diagnosis could be estabIished and the treatment instituted within the first few hours of the disease rather than within the first few days, the mortaIity_ couId be made comparabIe to that ot acute appendicitis. The big probIem in intestinn1 obstruction is one of earlier diagnosis. unquestionably Our conceptron of the disease has too Iong been based on a clinical picture drawn from its terminn stages and not from its earliest manifestations. Even Cope, in his exceIIent monograph “The EarIy Diagnosis of the Acute Abdomen,” mentions fecaI vomiting as a point for differentia1 diagnosis when considering intestinal obstruction, and yet m-e know that fecal vomiting is a symptom of obstruction of man37 hours’ standing and is extremely grave in its prognostic significance. In attempting to reduce the mortalit?; then, we must certainIy direct our efforts toward earlier diagnosis, and anything that shows promise along that Iine commands our earnest consideration. The use of the flat roentgen-ray plate in the diagnosis of intestinal obstruction was first suggested by Case in 1914.~