Capacity adapted to ingesta, rich and nutritious food improves breeds, excessive filling renders paretic, dilates; obstructions, impactions, strangulations, hernias, invaginations, twisting, tumors, compressions, calculi, lowered innervation, impaired circulation, verminous aneurism, peritonitis, persistent umbilical vesicle in horse and ox, hernia of mucous through muscular coat, cæcal dilatation, colic, rectal, with atresia ani, diseased end of cord, retained fæces. Symptoms: colics after meals, abdominal and rectal exploration, softer than impaction. Treatment: empty mechanically or by laxatives, demulcents, kneading, stimulants, nux vomica, ergot, barium chloride, eserine, rich concentrated food, electricity, enemata, laxatives.
It is a physiological law that the intestine developes in ratio with the demands made upon it, provided these demands are not too sudden and extreme. Thus the domestic pig and rabbit have intestines at once longer and more capacious than those of the wild varieties. The same is true of cattle and even of horses, heavy, rich feeding, generation after generation, increases the capacity to take in and utilize more, and to attain to a larger size and earlier maturity. In such a case the walls of the intestinal canal retain their primary thickness and strength and the whole change is in the direction of physiological improvement for economical ends.
When, however, the retention or habitual accumulation of food in the alimentary canal exceeds the self-adapting powers of its walls a true pathological dilatation takes place, and attenuation or thickening and paresis or actual paralysis of the walls ensues.
Whatever interferes with the normal active movement of the ingesta predisposes to this. Thus partial obstructions of all kinds, strictures, impactions, strangulations, hernias, invaginations, twisting, tumors, compressions, calculi, contribute to the overfilling of the bowel in front of them and to its more or less speedy dilatation. Whatever weakens the muscular walls of the bowels or the nerves presiding over these has a similar effect. Thus pressure on the solar plexus or its branches from any cause, or degeneration of the same, a tardy and imperfect circulation resulting from verminous aneurism and thrombosis, and a circumscribed peritonitis extending from the serous to the muscular coat of the bowel act in this way.
The persistence of the canal of the umbilical vesicle has been repeatedly observed in solipeds, in the form of a pouch or dilatation connected with the ileum three or four inches in front of the ileo-cæcal valve. Rauscher records one of these of thirteen inches long and having a capacity of seven quarts. These have been noticed in cattle as well.
Another form of sacculation results from rupture of the muscular coat through which the mucous forms a hernial sac in the peritoneal cavity. On a small scale these sacs are not uncommon, the size of a pea, a bean, or a marble, and very often containing larval or mature worms. Degive records an enormous dilatation of the horse’s cæcum, Peuch, one of the pelvic flexure of the colon having a capacity of forty pounds, and Simonin one of the floating colon. Dilatations of the rectum always take place in the new born affected with atresia ani.
Dilatation of the rectum into a cloaca is found in the horse and ox, often connected with disease or injury of the terminal part of the spinal cord, and is very common in dogs and cats in connection with the compulsory retention of the fæces indoors. Pigs also present instances of the kind.
The symptoms are in the main slight colics, with or without tympany and recurring after each meal. In the small animals the distended gut may often be recognized by palpation through the abdominal walls, and in the larger animals by rectal exploration. The distended viscus has not the firmness nor hardness of impaction or calculus and is mainly recognizable by its bulk and form. When the distension is in the rectum it may be easily reached and contents dislodged with the effect of giving complete relief for the time being.
Treatment. Treatment is necessarily mainly palliative and consists in the removal of abnormal accumulations. From the rectum this can be done with the hand, or in the smaller animals with the finger. For abnormal dilatations more anterior, purgatives and mucilaginous injections are required, with kneading of the bowels through the abdominal walls, or through the rectum in the larger animals, and stimulation of the peristalsis by nux vomica, ergot, barium chloride or eserine.
Having unloaded the dilated portion of any undue collection, further accumulation should be guarded against by giving nutritious food in small compass, and of a laxative nature, by stimulating peristalsis by nux vomica or other nerve stimulant and by the daily application of electricity. Enemata and laxatives should be employed when necessary.
From healing of ulcers, inflammation or infiltration, neoplasms, ring like or sacculated, in small intestine in horse preceded by a dilatation, an effect of verminous thrombosis; in cattle; in dog. Symptoms: Progressive, if in duodenum can’t eat full meal, belches gas, has colics and tympany; in cattle tympany, unthrift; in dog vomiting, tympany, colic, accumulations. Treatment: Gradual stretching by bougies if within reach.
Strictures of the intestine are in the main the result of ulceration of the intestinal walls which contract in healing, or inflammation, and infiltration which leads to contraction in their organization into tissue. Neoplasms of the walls (cancer, myxoma, lipoma, polypus, melanosis, actinomycosis, tubercle) are additional causes of constriction. If resulting from a lesion which completely encircled the bowel there is an uniform constriction in the form of a circular ring; if on the other hand it started from a longitudinal ulcer or lesion the bowel is shortened on that side and puckered.
In solipeds strictures are most frequent in the small intestine, or rectum. The pylorus is often affected. When on the small intestine there is constantly a dilatation just in front of the obstruction. The constricted portion is usually short, but as seen from outside of the gut may be duplicated a number of times. Cadeac mentions seventeen such strictures in the same animal, each preceded by a dilatation. The individual stricture may be less than two inches in length and so narrow as just to allow the passage of the index finger. The walls of many times their natural thickness, are still further thickened by an external layer of adipose tissue. It may be the seat of a small abscess, or of a tumor. Internally the mucosa may show ulcerations.
The stricture or strictures in solipeds often depend on the disturbance of the circulation which results from verminous thrombosis, the exudate into the intestinal walls, undergoing organization, at once thickens and constricts the tube, and determines as secondary result the dilatation in front of it.
Professor Mauri of Toulouse records the case of a horse with a rectal stricture 4 inches from the anus, and a great dilatation in front. The removal of the stricture, secured normal defecation, (whereas before this the fæces had to be removed by hand) and the colics entirely disappeared.
In cattle strictures have been found mainly at or near the pylorus, less frequently in the rectum, and on one occasion (Revel) in connection with a cancerous tumor, in the colon.
In the dog the pylorus is also the favorite seat of thickening and stricture, yet it may occur in the small intestine, the rectum, or the colon.
Symptoms. These are gradually advancing, as the stricture approaches more and more nearly to a complete stenosis. If the stricture is in the pylorus or duodenum, the patient can not eat a full feed of grain without discomfort. He stops, hangs back on the halter, plants the fore feet in front, arches the neck, drawing in the nose and eructating gas. If he cannot eructate he is liable to show colics, tympany, and the general symptoms of gaseous indigestion of the stomach.
In cattle there is tympany, partial loss of appetite, tardy rumination, and loss of condition.
Dogs show vomiting as a prominent symptom. When the stricture is in the rectum there is a gradual lessening of the amount of fæces passed at a time and an accumulation of feculent masses in advance of the obstruction, recognizable by rectal exploration. When in the terminal part of the small intestine or in the colon, a gradual lessening of defecation, with tympanies and colics, culminating in complete obstruction, may afford a suggestion of the trouble but no means of certain diagnosis. In the smaller animals some additional indications may be had from abdominal palpation.
Treatment is usually hopeless unless the stricture is in the terminal portion of the rectum. In the latter case gradual dilatation by the passage of the hand, the finger, or of bougies which are used larger and larger, as they can be forced through with moderate pressure may secure a sufficient dilatation. Forced dilatation, or even careful incision at several different points of the circumference of the stricture may give good results in certain cases.
Definition. Seat: ileum into cæcum, rectum through sphincter, duodenum into stomach, floating small intestine into itself, cæcum into colon. Lesions: blocking, or tearing of mesentery, dark congestion, peritoneal adhesions, incarcerate gut, necroses, sloughing of invagination. Symptoms: colics of obstruction, enteritis, and septic infection, eructation, emesis, tenesmus, signs of sepsis and collapse, death in seven hours or more, or recovery by disinvagination or sloughing. Diagnosis: by rectal exploration or passing of slough. Treatment: oily laxatives, demulcents, enemata, mechanical restoration of everted rectum, laparotomy.
Definition. The sliding of one portion of an intestine into a more dilated one, as if a few inches of the leg of a stocking were drawn within an adjoining portion which is continuous with it.
Seat. It is most commonly seen in the inversion of the small intestine into itself or into the cæcum, or next to this the passage of the rectum through the sphincter ani, to constitute eversion of the rectum. It would appear to be possible at any part of the intestinal canal in the horse, in which the bowels are more free to move than they are in ruminants. Peuch records a case of invagination of the duodenum into the stomach and Cadeac gives a woodcut of such a case, which one would suppose the fixed position of the duodenum would render impossible. It is conceivable that the jejunum could be invaginated into the duodenum, and that this should have continued until it extended into the stomach, but it is difficult to see how the duodenum itself could have passed into the stomach without tearing itself loose from its connections with the pancreas, liver and transverse colon.
Schrœder, Serres and Lafosse describe cases in which the small intestine was everted into the cæcum and thence through the colon and rectum until it protruded from the anus.
The invagination of the floating small intestine into itself is common at any point, and extensive and even repeated. Marcout records a case in which 24 feet were invaginated, and Rey a case of quadruple invagination at the same point.
The invagination of the cæcum into the colon is frequent, the blind end of the cæcum falling into the body of the same organ, and this continuing to increase until it passes on into the colon, and even carries a portion of the small intestine with it. This lesion is more rare in solipeds because the cæcum has its blind end lowest and gravitation opposes its invagination.
Resulting Lesions. In any case of invagination it must be noted that it is not the intestine alone which slips into its fellow, but it carries with it its attaching mesentery, which, dragging on one side of the invaginated gut, shortens and puckers that and turns its opening against the wall of the enclosing gut so as to block it, while the opposite or free side passes on and tends to form convolutions. If the outer and enveloping intestine is too small to allow of this, the detaining mesentery of the invaginated mass must be torn or stretched unduly and its circulation and innervation correspondingly impaired. When the invagination occurs of one portion of the small intestine into another of nearly equal size, the resulting mass is firm like a stuffed sausage, and this enlargement and consolidation ends abruptly at the point of visible entrance of the smaller contracted portion, into the larger dilated one.
If recent, the invaginated mass is still easily disengaged from the enveloping portion, though considerably congested and dark in color in proportion to the duration of the lesion. When it has been longer confined the incarcerated portion is the seat of extreme congestion, and extravasation, and has a dark red or black color. The exudation into its substance, which is especially abundant in the mucosa and submucosa, produces a thickening which may virtually close the lumen, and on the opposing peritoneal surfaces leads to adhesions which prevent the extraction of the imprisoned mass. The interruption of the circulation and the compression of the invaginated mass, leads soon to necrosis and thus a specially offensive odor is produced, and if the animal survives the whole may be sloughed off and passed with the fæces, the ends of the intussuscepted portion and of that receiving it meanwhile uniting and becoming continuous with each other.
Symptoms. These are the violent colic of obstruction of the bowels, soon complicated by those of enteritis and finally of septic infection.
The animal looks at his flank, paws, kicks with his hind feet, lies down, rolls, sits on his haunches, waves the head from side to side, and sometimes eructates or even vomits. Straining may be violent, with the passage of a few mucus-covered balls only, and rumbling may continue for a time if the small intestines only are involved.
The partial subsidence of the acute pains, the presence of tremors, dullness and stupor, the coldness of the ears and limbs, the small, weak or imperceptible pulsations, the cold sweats, dilated pupils, and loss of intelligence in the expression of the eye and countenance may indicate gangrene, and bespeak an early death which may take place in seven hours.
The subsidence of the acute symptoms with improvement in the general appearance and partial recovery of appetite may indicate a spontaneous reduction of the invagination, an issue which may happily arrive in any case in the early stages, but especially in those implicating the cæcum and colon.
An absolutely certain diagnosis is rarely possible, unless the lesion is a protrusion of the rectum, or unless as the disease advances the invaginated part is sloughed off and passed per anum.
Treatment. The failure to make a certain diagnosis usually stands in the way of intelligent treatment. Oleaginous laxatives and mucilaginous gruels are advised to keep the contents liquid, and favor their passage through the narrowed lumen of the invaginated bowel. In cases implicating the floating colon and rectum abundant watery or mucilaginous injections may assist in restoring a bowel which has not been too long displaced. In case of eversion of the rectum, the hand should be inserted into the protruding gut and carried on till it passes through the sphincter ani. Then, by pushing it onward, the arm carries in a portion of the invaginated gut and usually of the outer portion next to the anus as well, and this should be assisted by the other free hand, and even if necessary by those of an assistant, and whatever is passed through the sphincter should be carefully retained, while the arm is withdrawn for a second movement of the same kind, and this should be repeated until the whole protruding mass has been replaced.
Invaginations situated more anteriorly and which can be correctly diagnosed by rectal exploration or otherwise, will sometimes warrant laparotomy, especially those of the cæcum into the colon, where adhesion of the peritoneal surfaces is less common or longer delayed. The patient should be given chloroform or ether, the abdominal walls should be washed and treated with antiseptics, and the incision made back of the sternum and to one side of the median line, and large enough to admit the exploring hand. It has also been suggested to introduce the hand through the inguinal ring, or behind the posterior border of the internal oblique muscle.
Double colon cannot be invaginated, floating small intestine, cæcum and floating colon can. Causes. Lesions. Symptoms: Acute, violent, persistent colic, palpation of right flank causes gurgling, rectal exploration, prostration, collapse. Duration 1 to 5 weeks. Treatment: Laxative, enemata, injections of sodium bicarbonate and tartaric acid, laparotomy.
In these animals the double colon is rolled around itself between the folds of the great mesentery the free border of which supports the small intestine. The arrangement is as if a piece of rubber tubing were first doubled upon itself, and the end of the loop were then turned inward and the remainder wound round it as a centre. If this were then sewed between two pieces of cloth, the stitches passing between the different windings of the tube at all points, we would have an arrangement fairly representing that of the double colon of ruminants, and, for our present purpose, of swine as well. It must be evident that no portion of a tube arranged in this way can slide into another. It would also appear that the small intestine cannot become invaginated to any extent into another portion or into the cæcum without extreme stretching or laceration of the small portion of mesentery left between it and the coils of the double colon above. The anatomical arrangement is therefore opposed to the formation of invaginations in a way that is not the case in the horse.
Yet invaginations are by no means unknown in these genera. The small intestine can be invaginated into itself or into the cæcum. The cæcum, which floats loose at the right side of the mesentery that envelopes the double colon, can be invaginated into the colon, and the floating colon can be invaginated into the double colon on the one hand and into the rectum and through the anus on the other. Invagination into the rectum, for eight inches, in a bull calf, of six days old, is reported by Cartwright in the Veterinarian for 1829. In a similar case of Youatt’s the intussuscepted portion sloughed off and was discharged per anum.
The causes are like those acting in solipeds, and which give rise to excessive and irregular peristalsis. A drink of ice cold water, indigestions and colics of various kinds, diarrhœa, chills, the irritation caused by poisons or parasites, and the paresis and dilatation of portions of the intestine into which the more active portions can easily pass. Almost any irritation or congestion may cause intussusception, and young animals in which peristalsis is most energetic are the most liable.
Lesions. The intussusception is usually found in the ileum and to a less extent in other parts of the small intestine, or involving the cæcum and colon, or again the floating colon and rectum. The successive conditions of congestion, exudation, adhesion, obstruction, necrosis, sloughing, and repair by union of the remaining ends are the same as in the horse.
Symptoms. There is acute, agonizing and dangerous colic in an animal in which these troubles are usually comparatively slight and transient. The animal looks at the right flank, paws or stamps with fore feet as well as hind, lies down and rises often, strains to pass manure but passes only mucus or a few small hard masses, if anything. If pressure is made on the right side of the abdomen and the hand suddenly withdrawn there is a significant gurgling and the corresponding hind foot is lifted or moved forward or backward, appetite and rumination are lost, the pulse becomes rapid and weak, and the animal becomes prostrate, dull and stupid, often remaining recumbent in spite of all efforts to raise him. Rectal exploration may detect the firm tender mass in the seat of the invagination. The disease may last from one week to five, according as the obstruction is complete or partial. The usual termination is a fatal one, though a certain number of spontaneous recoveries are met with.
Treatment. By a happy accident the peristalsis or anti-peristalsis determined by a purgative will sometimes disengage the intussuscepted bowel. Copious injections into the rectum may also prove useful in case of intussusception of the floating colon or rectum. Or the disengagement of carbon dioxide from the injection of solutions of sodium bicarbonate and tartaric acid may be tried. Laparotomy is however the most radical measure when a certain diagnosis has been made and this is less dangerous in the cow than in the horse in which peritonitis is so grave. Under antiseptic precautions an incision is made in the right flank and the invagination found and reduced. In case firm adhesions have already taken place, and above all if the included gut is apparently gangrenous, the latter may be exposed by breaking down the connections at the side opposite to the attachment of the mesentery, or where the adhesions are least firm, then cutting out and removing the incarcerated gut and carefully closing the opening between the ends by suture. The use of a sublimate or carbolic acid solution and careful suturing and bandaging of the external wound with carbolated cotton wool will often give a successful issue.
Anatomical conditions favor. Causes: as in other animals, common in icterus, and surgical operations from deranged peristalsis. Lesions: most common in small intestines, congestion, inflammation, necrosis, sloughing. Symptoms: may be colic, but not always, dullness, anorexia, vomiting, constipation, palpation, swelling firmer than from impacted twine. Treatment: shot, castor oil and exercise on hind legs. Demulcents. Laparotomy.
The intestines of the carnivora are more open to invagination than in other domestic animals for even the colon is free enough throughout its course to allow of one part sliding into another. The causes to which it is attributed are in kind the same as in other domestic animals. The swallowing of ice cold water in excess when heated, diarrhœa, superpurgation, intestinal worms, the active peristalsis of early life, and jaundice have been especially blamed. Reynal found intussusception twenty times in forty cases of icterus and Rancilla four times in five cases. It has been frequently seen after severe surgical operations, and it is surmised that in both cases alike the deranged peristalsis attendant on severe suffering was the cause of the accident.
Seat and Lesions. The most common seat of invagination is in the small intestines, and less so in the cæcum and colon, or rectum. The lesions are as in the other animals, congestion, infiltration, adhesion, necrosis, gangrene and sloughing.
Symptoms. There may be colics as in the larger animals, but in some instances there are simply prostration, dullness, inappetence, vomiting, constipation, or the passage of a little liquid and fœtid excrement. Palpation of the abdomen detects a firm, cylindroid and very tender swelling on the line of the softer intestine which taken with the other symptoms is nearly pathognomonic. If situated in the small intestine and disconnected from the rectum and pelvis the diagnosis is more satisfactory. Impaction is most commonly in the rectum and floating colon and can be traced into the pelvis and even felt by the finger introduced into the anus. It might be confounded with obstruction of the intestine by the ingestion of twine, but the swelling is usually firmer and the cylindroid outline more uniform in intussusception.
Treatment. The measures recommended for the larger animals are applicable to the dog. Cadeac has had four recoveries in seven cases after the use of leaden shot and castor oil. Three balls of No. 16 calibre are dipped in castor oil and given to the dog. This is followed by ½ oz. of castor oil slightly heated, and walking or running exercise, or take the dog by his fore limbs and walk him around on his hind. No drink is allowed for 24 hours, and a quart of decoction of flax seed on the day following.
Should these measures fail, laparotomy is available, yet it is more promising in proportion as it is resorted to early, before ulceration, or gangrene has set in. The manipulations are practically the same as in the ox and the outcome is even more promising. The diet should be restricted to milk or mucilaginous gruels for a week after the operation.