Peritonitis as a Cause of Increased Peristalsis in the Rectum and in Other Parts of the Intestine
Authors: C. W. Cathcart
Journal: BMJ (1899)

felt to harden when it was pressed.The rectum contained a little blood and mucus.Operation.-Ananaesthetic was given anid laparotomy performed seven and a half hours after the onset of the symptoms.The opening was made in the right liniea semilunaris.immediately over the tumour.The intus- susception, wlhich was five inclhes long, was brouglht outside the abdomen.It was reduced without difficulty except its last half inch, the reduction of which requir-ed considerable care.The ileo-cascal valve formed the apex of the intussuscepted bowel.The abdomen was closed in the usual manner, the wlhole operati.?n lasting only nineteen minutes.After-history.-The patieit's recovery was rapid and complete.For a fe'v (lays after the operation hie lhad a good deal of bronchitis, aggravated by his getting out of bed witlhin a few hours of the operation.The bowels were opened naturally on the fourtli day and he passed a hard fTecal mass which was covered witlh blood.The stitches were removed on the eightlh day, and lhe was discharged from the hospital early in May wearing a small abdominal belt to support the operation scar.CASE III.-ACUTE ILEO-C.ECAL INTUSSUSCEPTION: ABDOMINAL SECTION: REDUCTION: RECOVERY.Jlistory.-A.T., a boy, aged 3 years, was admitted into the General Hos- pital, Bii:minghaam, oI March 29th (just twenty-four hours after the pre- vious patient) sutfering from abdominal pain anid vomiting.At I P.M. on the day of admission, slhortly after straining at the closet without any action of the bowels, he was seized witlh violent paiin in the right side of tlhe abdomen.He vomited several times during the afternooin, and lhad repeated attacks of abdominal colic.About an lhour before admiiission lie became profoundly collapsed and convulsed; he afterwards again vomited, and the collapse passed off.He had previously been in good lhealtl, though the action of the bowels lhad been somewhat irregular.Condition on Admission.-Thetemperature was I000 F., his pulse 96, small and regular.At times he lay apparently quite confortable, and would allow firm palpation of tlle abdomen.But at intervals lhe was seized with attacks of colic, wlhiclh produced a good deal of collapse.The abdominal walls wvere blistered and inflamed, the resuilt of hot turpentine fomenta- tions.In the intervals between the attacks of colic a small sausage-slhaped mass could be dlistinctly felt to tlhe riglht of and below the umbilicus; the iiass was not tender, and was freely movable.Tlle rectum was empty.Tile bowels had been opened once after the beginning of the illness.Operation.-Thediagnosis of intussusception beillg fairly clear, the patient was at once anTestlietised.anid laparotomy performedl seven hours after tile commencemenit of his symptoms.A 3-1inch incision was inade in thie riglt linea semiluniaris, and tile tumour exposed.It was brought out- side the abdomen witlh some difficuilty.The tension on its mesentery in order to do this produced a good deal of NIiock, which passed off wlhen it was r;elieved.The intussuseeptioni was a-n ileo-caecal one, ald measured 3.' inichles.The invaginated bowel wvas easily reduced except for its last ilhI.This was swollen and cedellatous, anl after reduction appeared as a raised cedematous ring on the surface of tlhe intestine.Tlhe abdominal wound was closed, and tlhe intlamned and vesicated skin arouild freely (lusted with boracic acid pow(ler.After-histor-7.-Notwvithstan(ding the raw state of the abdomen the wounldl healed by first intelitioll, and the stitches were all removed on tlle eighth day.The bowels wer-e opened on tile third day after the oper-a- tion, and a hard blood-stained fccal miiass was passedl.Tlhey ivei-r afterwards kept open regiular-ly by small doses of cascara sagrada.Tllc boy was kept in bed a montlh to coilsolidate the operationi scar.Ite was (liscilarged well from the hospital on May 15th, and lias remained inl good lcaltlh since.CASE IV.-ILEO-C.ECAL INTmSSUSCEPTION: ABDO3IX.NAL SECTION:COTLOTOMYNIY: RECOVERY.Ihistory.-OnSeptenlber 2nd, I898.I sawvW.M., with Dr. Gifford, of Birierley Hill