This section is from the book "Diseases Of The Intestines", by Max Einhorn. Also available from Amazon: Diseases Of The Intestines A Text-Book For Practitioners And Students Of Medicine.
Partial paralysis of the intestines may occur and give rise to symptoms resembling a complete occlusion of the intestinal lumen. Paralysis arising in consequence of a mechanical obstacle to the passage of the intestinal contents has been described above. Here we shall deal with primary paralysis of the intestine without any organic obstacle. In this condition the peristaltic motion of this organ is absent. The passage of fecal matter is thereby interrupted and symptoms of obstruction result.
Henrot 1 distinguishes three forms of intestinal paralysis:
1. Direct paralysis of a portion of the intestine caused by alterations of its walls. Thus an intestinal coil may become paralyzed after repeated forced reposition of a hernia or after it has been incarcerated in the hernial pouch for a long time. The paralysis may also occur as a consequence of a direct trauma or after extensive abdominal operations, and finally after various chronic inflammatory and ulcerative processes of the intestine (enteritis, tuberculosis, dysentery).
2. The paralysis is caused indirectly in consequence of a reflex nervous action. Thus contusion of the testicles, inflammation of a hydrocele, abscesses of the abdomen may inhibit the abdominal nerve centre in such a way that the peristalsis ceases, although this is of very rare occurrence.
1 Henrot: "Des Pseudo-etranglements, " Paris, 1865.
3. The intestinal paralysis may result from general neuroses (hysteria), from psychoses (melancholia, hypochondria), or from affections of the central nervous system (meningitis, brain tumors, tabes dorsalis, myelitis, etc.).
Besides these three groups, which are all of a more or less acute character, Rosenheim also mentions paralysis of the intestines as a consequence of coprostasis due to atony of this organ, which condition is less acute and more protracted. The patient, as a rule, has suffered from constipation for a long time. Evacuation of the bowels has been artificially produced only after the appearance of many annoying symptoms. At last the usual remedies refuse to work and the patient now becomes a chronic sufferer. Dyspepsia, intense meteorism, and palpitations of the heart are present. The ingestion of food grows smaller every day and the patient becomes weaker. This condition may last for weeks and months, and if no radical remedies are resorted to, the patient may ultimately be seized with fecal vomiting and die of the intestinal paralysis.
According to Rosenheim, a sudden attack of serious intestinal obstruction in a patient suffering from chronic constipation is, as a rule, not caused by paralysis of the intestine, but rather by an occlusion of the intestinal lumen through hardened fecal matter.
The diagnosis of intestinal paralysis can be made if all the other numerous factors causing ileus can be excluded and one of the above-mentioned etiological points can be discovered. The treatment of these cases consists in the application of electricity (recto-abdominal galvanization), massage, and purgative high rectal injections. Cases in which the paralysis is caused by chronic constipation must be treated by high injections of either ice water two hundred to five hundred grams, or water with the addition of two hundred to five hundred grams of oil. These injections should be applied twice or three times a day for several days in succession until a satisfactory result has been obtained. Massage and electricity can be used in addition to these injections. Internal purgatives, even croton oil, are not efficacious in this class of cases. The use of mercury, however, in doses of three hundred to eight hundred grams is here of great value. In cases in which the lower part of the colon is the seat of the paralysis, the stagnant fecal matter must be removed with the hand before the rectal injection is resorted to.
Proctospasmu8, or Spasm of the Rectum.
This condition consists in attacks of painful contraction of the sphincters of the rectum and is in most instances a secondary affection. It is mostly found in inflammatory and ulcerative processes of the rectum and colon, in fissure of the anus, and also in inflammatory diseases of neighboring organs, bladder, prostate, uterus.
Spasm of the rectum may, however, occur also independently as a primary nervous affection. As such it is principally met with in individuals with a nervous taint, and in diseases of the spinal cord. The attacks of proctospas-mus differ in intensity and also in duration. Sometimes they last only a short while, a few minutes, sometimes several hours or even days. In the milder form defecation is accompanied by intense pains and takes place only after great effort. In the severer forms there is a strong desire for defecation, but notwithstanding the most intense pains and great straining there is no movement of the bowels. If these attacks last several hours they greatly weaken the patient and render him very despondent. The anus is very sensitive to touch, and a digital examination of the rectum during the spasm is hardly ever possible. A thorough examination of the rectum can be made only during anaesthesia. In instances of very severe proctospasmus a transient paresis or paralysis of the sphincter muscles may result.
The diagnosis of proctospasmus is easy, as the symptoms are very distinct. The diagnosis of the primary nervous form will be made if organic diseases of the rectum and of the neighboring organs can be excluded.
The treatment must be directed principally toward the primary affection. In cases of nervous proctospasmus the treatment should be symptomatic and consist in the use of narcotic remedies. In severe forms of this malady hypodermic injections of morphine must be resorted to. In some instances a forcible divulsion of the sphincter under chloroform narcosis may become necessary.