Experimental Intestinal Obstruction.

Abstract

To determine the rôle of biliary, pancreatic, and duodenal secretions in the rapid death of acute intestinal obstruction an experiment was devised which permitted these three secretions to be short circuited into the bowel below the point of obstruction. This was done by operations on dogs in 2 and 3 stages, the latter giving the better results. Before producing the obstruction which was done as the last stage, the jejunum just beyond its junction with the duodenum was sectioned and the proximal portion anastomosed to the ileum. Then a pylorectomy was done and the distal portion of the jejunum was anastomosed to the stomach. In this way the duodenum emptied into the ileum, and the stomach into the jejunum.

Following this procedure the animals often lost weight, had a diarrhea, became progressively weak, and died of exhaustion or bronchopneumonia. Two developed chronic ulcers of the jejunum. Those which survived and were in good condition were obstructed by sectioning the bowel above the anastomosis in the ileum and invaginating the stumps with a purse string suture. Six dogs with obstruction produced in this manner lived from 12 to 33 days. With the obstruction 1 foot from the stomach the dog lived 12 days. At 20 inches the duration was 29 days. At 2½ feet the duration was 17 and 33 days. Three feet from stomach was lethal in 27 days. At 5 feet it was 17 days.

The behavior of these animals was not at all like ordinary obstructed animals which die in 2 to 7 days. They were quite lively, would walk and sometimes run, The average intake was 200 to 400 cc. of water a day to which glucose and sodium chloride were often added. Vomiting occurred about every second to third day. The urine output averaged 100 to 250 cc. per day. Small black or brown stools were passed on the average of every fourth or fifth day.