RUPTURE OF THE INTESTINE. SOLIPEDS.
Causes: overdistensions in front of obstructions, softening, friability, necrosis, suppuration or ulceration, Duodenum from worms or perforation by pointed bodies, exudate in verminous embolism, petechial fever. Jejunum and ileum, by disease of walls, ulcers, abscesses, neoplasms, caustics in umbilical hernia, clamping of hernia. Cæcum, falls, blows, kicks, blows of horn, tusk, stump, calculi, abscesses, cauterizing of hernia. Colon, external traumas, calculi, worms, verminous thrombosis, neoplasms, abscesses, overdistensions, violent straining, arsenic. Symptoms: follow accident, signs of obstruction, no rumbling, tympany, stiffness, great prostration, fever. Death in short time.
Causes. Ruptures occur as we have already seen from overdistensions of the bowel in front of some obstruction, by ingesta, concretions, calculi, foreign bodies, etc., and this may take place in the most healthy organs. In other cases, however, there has been some pathological process at work rendering the intestinal wall soft, friable, necrotic, suppurative or ulcerative, by which its substance is attenuated or its consistency or cohesion reduced.
Duodenum. Lacerations of the duodenum are often connected with obstruction by tumors or the ravages of worms. These latter are mostly the ascaris megalocephala, accumulated in mass, and sometimes engaged in pouches outside the walls of the gut. In other cases, the walls of the intestine have been perforated by hard woody stalks of straw or hay (Mollereau) or of still more woody plants as in a case observed by the author, and in which the pylorus was perforated. Sometimes the exudate or blood extravasation attending on petechial fever, or verminous embolism will pave the way for the rupture. Perforations by pieces of wire (Schmidt) or other metallic bodies are also observed. Adhesive peritonitis has also rendered the walls friable and predisposed to rupture.
Jejunum and Ileum. Lesions are most frequent toward the termination of the ileum and resulting from obstructions of the bowel or the weakening of the walls by disease, or both. Ulcerations, abscess of the closed follicles opening into the peritoneum, and neoplasms of various kinds are to be especially noted among the causes. The impaction of the cæcum, blocking the ileo-cæcal valve is also among the observed factors. Other instances have been traced to deep cauterization of an umbilical hernia, the enclosed loop of small intestine becoming inflamed and perforated. The author has observed one instance from clamping of a hernia in which the contained intestine was adherent to the hernial sac.
Cæcum. From its position on the lower part of the abdomen and from its habitual plenitude with food or water, this organ is especially exposed to direct mechanical injuries and ruptures. A sudden fall, more especially if the umbilical region strikes on a stone or other projecting solid body, kicks with heavy boots or with the feet of other animals, blows with a cow’s horn or a boar’s tusks, and violent contact with stumps, poles and other objects may be the occasion of the rupture. These are usually found near the base of the viscus and across its longitudinal direction.
Inflammations, connected with punctures, calculi, parasites, etc., may render the walls so friable that they give way under slight strain or injury. Abscesses have been found in the walls of the viscus leading to perforation, and extension of inflammation from an umbilicus cauterized for hernia has determined adhesion and perforation.
Colon. The loaded colon is even more liable to mechanical injury than the cæcum. Occupying as it does the more lateral parts of the abdominal floor, it is even more exposed to kicks and blows, and extending as it does back toward the inguinal regions, it is especially in the way of blows of horns so often delivered in this region. From the solid nature of its contents the presence of calculi, the presence of blood sucking worms, and its implication in the congestions and extravasations of verminous thrombosis, this organ is especially liable to degenerations and inflammations which render its walls particularly friable. Neoplasms of various kinds, cancerous, tubercular, etc., have been found on its walls as occasions of rupture. Abscesses of strangles have ruptured into the viscus. Overdistensions in front of an obstruction in the pelvic flexure, floating colon or rectum are the most frequent causes of rupture. Again, cases have been seen as the result of violent exertions, as during straining in dystokia. It has been a complication of phrenic hernia, of volvulus of the double colon, and of ulceration caused by the prolonged ingestion of arsenic. In severe impaction the necrosis of the intestinal walls has proved a direct cause of laceration. The seat of these ruptures may be at any point, but it is most frequent in front of the pelvic flexure, or in the floating colon, or directly in the seat of impaction.
Symptoms. The attack comes on suddenly, perhaps in connection with some special accident or injury, and is manifested by violent colicy pains which show no complete intermission. In many respects the symptoms resemble those of complete obstruction of the bowel, there is a suspension of peristalsis, rumbling, and defecation, a tendency to roll on the back and sit on the haunches, an oblivion of his surroundings and pain on pressing the abdomen. Usually the shock is marked in the dilated pupil, the weak or imperceptible pulse, the short, rapid breathing, cold ears, nose and limbs and the free perspirations. Tympany is usually present as the result of fermentation. Signs of infective peritonitis and auto-intoxication are shown in the extreme prostration, unsteady gait, dullness and stupor, and general symptoms of collapse. The temperature, at first normal, may rise to 105° or 106° as inflammation sets in, and may drop again prior to death.
Termination is fatal either by shock or by the resulting peritonitis and auto-intoxication. Exceptions may exist in case of adhesion of the diseased intestine to the walls of the abdomen and the formation of a fistula without implication of the peritoneum.