– Ileus (H. F. Biggar), American Institute of Homoeopathy, 1904, 60th Session,
Ileus, or obstruction of the bowel, whether acute or chronic, may arise from mechanical or neuropathic causes.
The purport of this paper will define the symptoms and the causes of either as far as it is possible and determine the necessary means to overcome the obstruction whether the character is mechanic or neurotic; and if mechanic what if any means shall be employed for the reduction of the obstruction before opening the abdomen.
It is stated that in seventy per cent. of the cases of obstruction previous conditions are restored without a surgical operation; and that only thirty-four per cent. require the knife. If this statement is correct then it seems very important to give the forms of treatment which have proved effectual. The fact, however, must not be over-looked that in mechanic obstruction the condition is serious per se and that any effort to reduce the same by adjuvant means would be censurable; and that nothing but surgery would give the least hope for recovery. It must, however, be admitted that some unusually desperate cases are relieved by adjuvant treatment, when at the onset it seemed unwise to delay surgical interference, where by the continued perseverance of the methods adopted the obstructions have been overcome. The careful consideration of the history and observation of pathological symptoms will determine the course to be employed.
The pathological varieties of mechanic ileus are occlusions which make their appearance very abruptly and rapidly, constituting true intestinal strangulations, as hernia, invagination, or volvulus, and are as follows:
1. External hernia; (a) inguinal, (b) femoral, (c) umbilical, (d) scrotal.
2. Internal strangulation or concealed hernia of peritoneal pockets, recognized usually by the history of a previous peritonitis, resulting in adhesions which may be followed by slits in the mesentery, intra-abdominal fossac or other acquired or congenital defects of the peritoneum and viscera as: (a) hernia duodenojejunalis, (b) pericecal hernia, (c) intersigmoid hernia, (d) properitoneal hernia, (e) hernia into the foramen of Winslow, and (f) diaphragmatic hernia.
3. Intussusception is a child’s disease – according to Leichtenstern forty-four per cent (44%) are of the ileocecal variety, and that of the colon eighteen per cent (18%). The seat of vagination varies according to period life. In children seventy per cent (70%) are of the ileocecal variety; colic intussusception is also frequent in childhood; intussusception of the small intestines is most frequent in adults, and chiefly the lower portion of the ileum.
4. Volvulus occurs more frequently in the sigmoid and in adults, but we must bear in mind that the “sigmoid flexure” occupies a much more prominent position in the abdominal cavity of infants and very young children than in adults, and from the long mesentery with narrow base which results in “congenital enlargement.” If the colon grows more rapidly than the abdominal or pelvic walls, it falls into numerous folds, which may result in a lengthening of the sigmoid loop and idiopathic enlargement. The mesentery of the small intestine may become lengthened in advanced life. From these conditions, with the addition of constipation and gas, which weaken the bowel and peristaltic action, it is no wonder that volvulus should follow.
Other portions of the intestine may be the seat of volvulus, and unusually long hepatic or splenic flexures may present the necessary anatomical conditions.
Can we differentiate between mechanic obstruction and interference from innervation? Yes, for if there is no temperature or if the temperature is subnormal with increased peristalsis there is mechanic interference.