Acute Intestinal Obstruction

THE problem of acute intestinal obstruction is well illustrated by the patient. some twenty years ago, who first raised my serious interest in the processes concernied. This patient, a well-nourished middle-aged mani, was admitted to hospital suffering from generalised crampy abdominal pain, vomiting, and constipation. On examination, the patient looked well; his abdomen was somewhat distendecd, and there was slight tenderness over the middle of the abdomenl. Under spinal anesthesia the abdomen was opened and a narrow obstructing banld dlivided and the obstruction relieved. The patient -did not seem in any way (disturbed by the operation, and one looked forward to a rapid conval'escence. Yet, twenty-four hours later, the patient's con(litioni rapidly deteriorated. 'I'he colour became blac, the nostrils pinchedi looking, the respirations rapid and(i shallow, and col(d sweat broke out on him. The pulse lost its volume, and he died shortly afterw.7ards in a condition resembling surgical shock. 'Ihe cause of the obstruction had been relieved, and he appeared to have recovere(d from the immediate effects of his operation. What factors had-brought about his death and how could these be combated? Through the kindlness of the staffs I have studie(d the recordls for the ten years of the Belfast Hospitals-Royal XVictoria, Belfast City, an(d Ulster Hospital. The results are epitomizedl in the following graphs (figs. I, II, llI, IV): FRANKAUl gives the followinig mortality figures for stranllgula(ted liernia with intestinal obstrut-ctiont: Inguinal hernia 15.4 per cent. Femoral hernia 16.6 per cent. Umbilical hernia 46.6 per cent.