Save in rare instances where stricture may be due to congenital defect the condition is never primary, but is secondary to some previous and active disease. Stricture proper should be distinguished from obstruction produced by compression from without and should usually be made to include those cases due to intrinsic disease of the intestinal wall. Here it is in the vast majority of cases either due to cicatricial contraction, following the healing of some previous lesion, or else to the infiltration and progress of malignant disease. In the former instances a great deal may be accomplished by operation. In the latter much will depend upon the relative period at which the case is seen by the surgeon.
Symptoms.
—The symptoms of stricture are those of bowel obstruction. The tumor which produces it may be identified by palpation, or by the fecal impaction, at least accumulation, which is likely to occur above it, which may appear as a tumor and be mistaken for it until cleared away by suitable cathartic measures. Ordinarily the surgeon never recognizes stricture of the small intestines, then, save by its obstructive features.
Treatment.
—The treatment consists in what can be done by radical surgical measures, and this can only be determined after exploratory abdominal section.
TUMORS OF THE SMALL INTESTINES.
Benign tumors of the small bowel are relatively infrequent, perhaps the most common being the lipomas which develop along the mesenteric border, usually as excessive epiploic appendages. But circumscribed and even pedunculated lipomas are seen occasionally in this location and are of surgical interest largely because, at points where they are located, intussusception is peculiarly liable to occur. In fact, the condition figures as one of the predisposing causes of invagination. Fibromas develop occasionally in the intestinal walls and adenomas grow from the glandular structures which abound therein. Other benign tumors are exceedingly rare.
Besides predisposing to intussusception these tumors are innocent, save that in time they constrict or obstruct the lumen and produce one form of stricture with obstruction, which will first be chronic and then terminate acutely and fatally unless promptly relieved.
All benign tumors of the bowel should be removed with the least harm possible to the bowel itself, but when a neat extirpation without reduction of intestinal caliber is not possible no hesitation should be felt about resecting a sufficient portion of the gut; or should this be impracticable in making an anastomosis, thus excluding that part of the bowel involved.