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.
Constipation almost always exists and is very obstinate. After injections, very rarely spontaneously, there may be a slight movement of the bowel consisting of the fecal matter lodged below the occluded spot. In some rare instances a catarrhal condition may exist in the segment of the bowel below the obstruction, and the patient then may rather have diarrhoea combined with tenesmus. Of greater significance than the absence of stools is the inability to pass wind through the anus. The passage of flatus is a sure sign that the permeability of the intestine has been re-established.
Meteorism is the result of increased formation of gas developing in consequence of putrefactive processes as well as of diminished absorption. According to Zuntz, the absorption of intestinal gases into the blood takes place only when the circulation is in good working order. Meteorism thus indirectly points to a disturbed circulation which is often found in cases of incarcerations. If meteorism is absent the absorption of gases must be assumed to take place as rapidly as their formation. Meteorism may be at first present at a certain circumscribed spot of the abdomen and later become more diffuse. If the place at which it first appears can be distinctly denned, this is of diagnostic importance with regard to the location of the occlusion.
If the occlusion is in the large bowel the portion situated between it and the ileocecal valve will become considerably distended with gas. Thus a protrusion of the right side of the abdomen will be noticed when the obstruction is at the right flexure. If the obstacle is situated in the rectum there is at first a protrusion of the left side of the abdomen and later the tympanites will involve the portion of the abdomen situated above the navel (course of the transverse colon). In some instances, however, obstruction of the rectum may be acompanied by more or less general meteorism. This is especially the case after the disease has lasted some time; for then, as a rule, the resistance of the ileocaecal valve is overcome by the gas pressure and it remains more or less patent in such a way that the gases easily penetrate the small intestine.
In occlusions affecting the duodenum or the upper part of the jejunum the meteorism as a rule involves the upper half of the abdomen, and remains confined to this area. After vomiting there is usually a perceptible decrease of the protrusion for a short while.
If the meteorism has lasted for some time and is intense, the abdomen assumes a barrel shape. This is especially found in cases in which the distended intestinal coils are already paralyzed. The accumulation of gas can now go on without encountering much resistance and thus do great harm. The diaphragm is then pushed upward. The lungs as well as the heart become compressed. Stomach, liver, and bladder are compressed by the intestinal coils filled with gas lying upon them. In a similar manner the large veins (vena cava, vena portae, etc.) are subjected to the same disturbance. Thus the function of many important vital organs is interfered with and impaired to such a degree, if this condition persists, that a fatal issue may occur.
The diverse symptoms of shock which appear in a marked degree in cases of ileus must be ascribed to the sudden damage inflicted upon the peritoneum and intestinal wall by the strangulating agent. The mechanical irritation involves first the splanchnic nerves, and through them the circulatory apparatus. As a consequence there are a lowering of the temperature of the surface, cold sweats, lividity of the extremities, anaemia of the brain, and a small and rapid pulse. The degree of the collapse depends upon the disposition of the patient, upon the suddenness of the strangulation, and upon the amount of peritoneum or of intestine involved in the lesion.
The gravest amount of shock is met with in cases in which a considerable segment of the intestine is suddenly strangulated and an injury thus abruptly inflicted upon an extensive nerve area. As a rule, the shock met with in cases of obstruction of the small intestine is much more pronounced than in cases in which the obstruction is situated in the large bowel. The reason for this is the greater supply of nerves and the greater activity of the small intestine as compared with the large bowel. The nerves of the small intestine are also more directly associated with the great sympathetic ganglia of the abdomen.
In intimate connection with the disturbance of the nerves and circulatory functions just described is the decrease in the amount of fluid in the blood. This is due to increased secretion in the intestine with absence of absorption, to vomiting, and to increased perspiration. As a consequence there exist dryness of the tongue and a tormenting thirst; the urine is also passed only in small quantities, and in some instances there may even be anuria.
Certain symptoms which occur bat rarely and also belong more or less to this group are cramps, tetanus, coma, delirium, fever. Whether these symptoms are due to auto-intoxication or to other factors (especially the dry condition of the blood) is as yet not settled.