Industrial Incapacity--II
Authors: D. Stewart
Journal: BMJ (1939)

was kinked above an aberrant branch of the mesenteric artery (Spriggs and Marxer, 1937). Intussusception and ActinomycosisWe have seen three cases of intussusception of the small intestine.In one the jejunum passed at intervals into the stomach through a gastro-enterostomy.This caused a burning scarified feeling which recurred on and off for four years.It was relieved by some foods, and always by a rest and holiday with general treatment.This patient has now been free of the sensation, and, at observations, of the intussusception, for six years.The second patient gave a four-years history of sudden nausea, vomiting, and pain, and on one occasion melaena.She had been treated for duodenal ulcer without benefit, and came to the clinic for investigation.Fortunately, an attack occurred in the x-ray room and the intussusception was seen.The infolding of the upper jejunum reduced spontaneously, and at operation was found to be due to a small adherent gland.Adhesions were separated, and there was no recurrence.In the third case, which is under observation, the terminal ileum passes into the caecum, with mild discomfort.Actinomycosis involving -the ileum occurred in a man of 28 who had had large amounts of fluid, containing the fungus, taken from the peritoneum before admission.Intensive treatment with iodide had given relief.The lesions of the intestine could be seen in the radiographs.With a quiet regimen and withdrawal of morphine the symptoms improved.A haemorrhagic cyst then developed about the pancreas after a trauma-namely, hitting the ground hard with a mashie, which caused acute pain.This was operated upon successfully.But after some months fresh pains developed, and a year later it was reported that death had followed repeated operations.Growths and Foreign Bodies Primary growths of the small bowel are rare, and are varied in nature.A short summary of those which have been observed is contained in a paper to which I have referred (Spriggs and Marxer, 1937).Secondary growths are usually at the later stage of a general dissemination.Pressure or extension from a neighbouring growth is not uncommon.Pain may be reflected towards the root of the mesentery and up to the left hypochondrium.In one patient a gall-stone caused acute obstruction.In two others tapeworm and roundworm respectively were detected in the terminal ileum by 0. A. Marxer with the aid of radiographs.The symptoms disappeared with appropriate treatment. SummaryThe acute diseases of the small intestine include gastro- enteritis, typhoid fever, and acute obstruction.Most of the chronic disorders met with in practice are due to peptic ulcer and its treatment by anastomosis with the jejunum, or to mechanical interference with the lower ileum from inflammations or operations in that region.Patients in the second group have not infrequently been labelled colitics or neurasthenics.A detailed clinical and radiological study is needed to determine the nature and site of the lesion.If an exact diagnosis can be made much relief is given by medical means in most, and by surgery in others.Chronic intrinsic diseases of the small intestine occurred in 3 per cent. of a series of 8,900 patients, and were, in order of frequency, diverticulosis, duodenal ileus, tuber- culosis, regional ileitis, secondary growths, intussusception, primary growths, actinomycosis, and foreign bodies.If duodenal pouches are excluded the frequency of an intrinsic disease of the jejunum and ileuim was 1 per cent.The symptoms and treatment of each group are briefly reviewed.