Evaluation of X-Ray Evidence as a Criterion of Strangulation Obstruction.

Abstract

Recently Wangensteen and Lynch 1 indicated that the accumulation of gas in the small intestine as visualized by X-ray examination was an early and reliable criterion of obstruction to the continuity of the bowel. In this study an attempt has been made to evaluate the significance of X-ray evidence in the early recognition of strangulation obstruction.

Strangulation obstruction in dogs was established under aseptic conditions employing local anesthesia (procaine) of the abdominal wall fortified by the preliminary injection of morphine sulphate.

In each instance about 24 inches of small intestine together with its mesentery was tied off about 18 inches above the ileocaecal valve. Umbilical cord tape was used for the tie and an attempt was made to establish varying grades of strangulation which might be designated on the basis of I-IV, IV being the maximal grade of strangulation obtained. In the grade IV strangulations, the blood supply to the loop was arrested; in grade III there was immediate congestion and discoloration of the bowel but slight pulsation could still be felt in the mesenteric loop beyond the ligature after placement of the tie. It was found to be extremely difficult to establish strangulation obstructions of grades I and II, and these experiments concern strangulation obstructions of grades III and IV. In 2 dogs mild (Grade I and II) strangulation obstructions were established; these survived the procedure and subsequent laparotomy showed the continuity of the bowel uninterrupted despite the angulation of the loop. Twelve animals in which grade III and IV strangulations were established serve as the basis for this report. Perforated lead shot were sewed to the mesenteric border of the strangulated loop in an effort to determine whether the bowel proximal to the obstruction or the strangulated loop distended most readily.