Value of X-Ray Evidence of Bowel Obstruction in Various States of Intestinal Stasis.

Abstract

X-ray evidence of gas in the small intestine in experimental simple mechanical obstruction and in strangulation obstruction has been reported previously., It was found that definite evidence of gaseous distention of the bowel proximal to a simple obstruction was present as early as 4 or 5 hours after the establishment of the obstruction and in 20 to 24 hours the intestinal distention was fairly general in the proximal bowel. The X-ray was not found to be of the same value in detecting the presence of strangulation as it was in the early recognition of simple obstruction of the intestine. These X-ray observations have now been extended to include cases of isolated loop obstruction, mesenteric vein ligation and experimental peritonitis. In 23 dogs, segments of intestine from 10 inches to 3 feet in length were isolated from the rest of the intestinal tract (ileum, jejunum or duodenum) and the ends were turned in forming loops obstructed at both ends. Intestinal continuity was re-established by end-to-end or lateral anastomosis. The obstructed loop may be regarded as a form of strangulation obstruction because of the interference with the vascular supply as a result of the greatly increased intra-intestinal pressure. The intestinal anastomosis obviated the confusing factor of an additional simple obstruction which was found difficult of evaluation in the interpretation of the findings in a previous study even though lead shot were attached to the strangulated segment. These dogs lived from 21 hours to 13 days (average 3.5 days), and post mortem examination revealed discoloration and distention of the obstructed loop, and peritonitis. Perforation of the loop was the cause of the peritonitis in one-third of the cases.