Radiograph showing tube in the rectum, a probe and bismuth in perirectal space, and also a probe in a submucous channel; a case of proctitis, sigmoiditis, periproctitis, and perisigmoiditis.
CHAPTER XXV.
Chronic Mucous Proctitis and Sigmoiditis—Usually Diagnosed as Chronic Mucous Colitis.
Chronic mucous colitis ought to mean inflammation of the ascending, transverse, or descending colon. The length of the rectum varies from five to eight inches, and the average length of the sigmoid flexure is about nineteen inches; the length of the two organs is thirty or more inches. Chronic follicular, ulcerative proctitis and sigmoiditis, extending half, or even the whole length of the sigmoid flexure, causes great suffering, and the symptoms are similar to those attributed to chronic mucous colitis. For about thirty years I have positively known that many of my patients suffered not only from chronic mucous proctitis, but from sigmoiditis as well, since I was able to make positive diagnosis of the diseased condition for at least ten to fifteen inches up the lower bowels.
If the anal canal is inflamed from any cause and not cured, the chronic inflammation will gradually extend up the whole length of the rectum and into the tissues of the sigmoid flexure, invading the organ to a greater part of its length, if not all of it. The sigmoid flexure is the normal receptacle for feces, and gases, and physiologically and hygienically ought to be emptied three times in twenty-four hours to keep it clean for those who are in the habit of eating food three times a day. The hygienic condition of the sigmoid receptacle is entirely dependent upon a healthy condition of the rectum and a sensible tenant of the body; but when chronic proctitis has taken possession of the rectum and neighboring tissues, it serves no longer as a normal passageway for emptying the sigmoid flexure of accumulated feces, gases, and liquids.
At first inflammation causes spasmodic muscular contraction of the anus and rectum, which in time becomes more and more permanent stricture as the progress of disease advances, lessening the bore of the organs until it becomes very difficult for anything to pass into and through the rectal and anal canals. Inflammation extending from the rectum into the sigmoid flexure for perhaps its whole length, interrupts its functions likewise, thus creating another cause for undue accumulation of feces and gases in the organ; this accumulation of the waste material of the body becomes very foul, generating toxic gases, putrid substances, and poisonous germs which in turn irritate and excite the diseased organ from their constant contact with the follicular ulcerated mucous membrane of the sigmoid receptacle. Why should we not find in these cases all the symptoms attributed by authors to chronic mucous colitis? Especially so when we have, in addition to the enumerated symptoms of colitis, those caused by periproctitis and perisigmoiditis, which are always present and quite severe.
As a rule, the symptoms which have been diagnosed as those of chronic mucous colitis, membranous colitis, or ulcerative colitis are nothing more than symptoms of chronic mucous proctitis and sigmoiditis, accompanied by periproctitis and perisigmoiditis. Proctologists who have written on the subject of mucous colitis have noted the many symptoms very accurately, but have missed the usual location of a most aggravating disease from which mankind suffers early and late in life. Authors of books on stomach and intestinal troubles are also groping very much in the dark and are unable to diagnose the cause of a very common functional disturbance of the whole digestive apparatus, caused by proctitis and sigmoiditis, bringing numerous and severe primary and secondary symptoms to which other diseases may be traced.
Chronic proctitis and sigmoiditis and their local symptoms convert the sigmoid receptacle into an Augean stable, from which foul poisonous gases and germs are forced up and along the bowels, distending the descending and transverse colon and finally reaching the ascending colon and the cæcum, causing undue retention of their contents; hence so much attention to the cæcum and the vermiform appendix. The ends of a long rubber tube distended with gas will exhibit more strain and disturbance than the intermediate parts, and the same is true of the colon, owing to the intermediate sections of the organ possessing greater mobility. The great volume of gases confined in the colon prevents its normal peristaltic action, causing undue retention of contents, with resulting inflammation of the cæcum, as well as dislocation of the stomach, colon, etc., and suggesting radiographic and fluoroscopic examination and surgical operations to discover the cause of all the trouble, which should have been learned through use of the speculum before so many complications occurred.
In all cases of chronic mucous proctitis and sigmoiditis where there is a great amount of secretion of mucus, membranous cords, shreds, and casts (called mucous colitis), I have found the marked acute symptoms more or less periodic and accompanied by increased inflammation in all the tissues involved in the disease, which convinced me that the colitis we read about had become dislocated and was where I could see its results without the use of a speculum.