Roentgenology has played a most significant rôle in the accomplishments of surgery. In visceral surgery, of the abdomen and thorax, the surgeon has become especially dependent upon information revealed by roentgenograms. The plate-reading room of the roentgenologist has become the informal consulting center for the surgeon, where both negative and positive roentgen findings are sought eagerly, and efforts are made at fusion and synthesis of factual data relating to obscure cases. In the proper interpretation of the significance of intestinal distention, the roentgen findings afford most helpful assistance, so useful, in fact, that this source of factual information must never be neglected by the clinician. I make no apologies in presuming to discuss before a body who considers its chief function the recognition of clinical disorders, the role of diagnostic criteria in the choice of therapeutic procedure in the management of a disorder. Preoccupied as you may be with the detection of the presence of bowel obstruction from the roentgen findings, I cannot believe that you are wholly uninterested in knowing how your decisions may influence what is done for the patient The responsibility between diagnosis and therapy is interlocked so intimately that a surgeon cannot say, “my interest concerns therapy alone”; nor a roentgenologist affect to affirm that his province is solely diagnosis and that his responsibility ceases therewith. In part, surgeons have become physicians within certain precincts of their own province, and the science as well as the art of surgery has become improved thereby. Skillful operators, untutored in the broader outlines of the problem presented by bowel obstruction, have made no contribution to the surgery of its relief. Roentgenology embraces the whole field of diagnostic medicine, employing many technics but essentially one diagnostic agent. Yet, the implications of your judgments permeate the province of therapy so obviously that of necessity you must be interested in the choice of therapeutic procedure unless you are wholly unconcerned over the effects of your decisions. Surgeons would be the last to say that their roentgen colleagues had laid aside this responsibility. In the hospital in which I work the informal intimacy of daily contact between roentgenologist and surgeon in the consulting center of the plate-reading room, and weekly in the surgico-radiologic conference, has established an identity and unity of interest in the patient. The Recognition of Acute Intestinal Obstruction There are here and there a few who cling still to the precepts of the old school that “acute abdomen” is synonymous with the necessity for operative intervention and who are prone to regard efforts at adjudication of the nature of the ailment present as mere academic excursions into the processes of the intellect, productive of no good.
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Apr 1, 1967
John J Joyce + 1
Open Access