1
THURSDAY. JUNE 13. 1963
MEDFOrD MAIL TRIBUNE. MEDFORD. OREGON
Tho Medical Roundup
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Emarilus Pro(eoi or sudicint
Mayo Clinic
(Rtfitur and Trlbun SyndlcaU.
mi)
Intestinal Obstruction
It 1 very Important that
people, and especially older
people, quickly recognize the
eariy my mr
to mi of intes-
tinal obstruc
tion. Usually
there is severe
a b d o m inal
pain, perhaps
likeawoman'f
at
labor pains,
five minuate
intervals-per-
wa naps eacn pain
ending in a gurgle. There may
be nausea and perhaps vom
iting, and perhaps an inabil
ity to pass gas or to move the
bowels.
'Because the commonest
cause of obstruction is an ad'
hesion, intestinal obstruction
is much more likely to occur
in a person who has had an
abdominal operation than In
a person who never had one.
A common cause of intestinal
obstruction Is a rupture in the
groin that has come down and
won't go back. Another cause
is an adhesion formed after
an appendix ruptured.
Sometimes a person can
feel that the bowel is blocked;
and every few minutes a wave
of contraction presses down
against the obstruction. Often
times the abdomen gets dis
tended with gas. The person
may soon become toxic and
dull, and his pulse rate will
become rapid. Occasionally
there ii some bloody diarrhea.
Eventually the person can go
into state of shock. An X-ray
film made of the abdomen
often shows great dilation of
part of the bowel with gas.
The diagnosis is harder to
make when the person is very
stout.
Possible at Any Time
Intestinal obstruction can
take place at any time in a
person's life, from infancy to
old age. The diagnosis must be
made quickly if the person's
' life is to be saved. An impor
tant factor in making the diag
nosis may be that the person
was kept awake all night with
intermittent pains. A patient
with such a story should be
taken immediately to a hos
pital. There one of the first
things the surgeon may do la
to put a tube into the stomach
so as to suck air out of that or
gan. When there la an enor
mous amount of gas in the
right side of the colon, a small
incision may be made through
the abdominal wall and into
the colon. The removal of
much gas can save the per
sons lite.
- It is important to give fluid
through Uiu veins-fluid to re
place the large amount lost by
vomiting. It helps in these
cases to give an antibiotic, be
cause this lowers the death
rate. The dunger is great
when the bowel is, as we phy
sicians say, strangulated, This
means that blood Is not able
to get into a segment of bowel
that is perhaps twisted. Some
times then at operation, the
bloodless segment of bowel is
found black and dead, and it
must be removed.
Drs. Zollinger, Kiruey and
Grant, of the Ohio SUte Uni
versity at Columbus, recently
wrote about operating on in
testinal obstructions. As the
doctors said, in spite of all
their efforts, whenever a bow
el was strangulated, 1 in 3 ol
the patients died. The mortal
ity rate is doubled if the dlug
nosis and treatment are de
layed tor more than 24 hours,
In two-thirds of those cases in
which the patient failed to re
cover, he or she had not been
placed in the hands of a sur
geon quickly enough. Obstruc
tions due to cancer of the
bowel are very dangerous to
life.
Didn't Rtallie
Sometimes a woman loses
her life with an intestinal ob
struction because for months
or years she had-in a way.
been crying wolf about a pain
due to nervousness, or an ir
ritable bowel. As a result,
when her bowel became ob
structed, her physician did not
realize that at last she had a
very severe and different pain
which called for an immed
iate operation.
Of the 311 cases of obstruc
tion of the small bowel stud
ied by Dr. Zollinger and his
associates, adhesions caused
65 per cent; a hernia (rup
ture) of some kind caused 13
per cent; a tumor in the bowel
caused 12 per cent; and sev
eral other rare conditions
caused the remainder.
The mortality rate of 10
per cent was really excellent.
Years ago, when I was an in
tern in a big city hospital, the
- mortality rate must have been
nearly SO per cent. One rea
son why intestinal obstruction
is so commonly fatal Is that in
more than half of the cases,
the patients were over 60
years of age. Such persons
cannot so easily stand the se
vere shock of an Intestinal obstruction.
fort can be caused by what
commonly Is called colitis. If
you'd like Dr. Alvarez' book'
let which fully explains coll
tis, send 23 cents and a
self -addressed, stamped en
velope with your request for
it to Dr. Walter C. Alvarez,
Dept. MMT, Box 957, Des
Moines 4, Iowa.
Trendelenberging May Be Detrimental In Cases of Shock
Br DELOS SMITH
UPI Science Editor
New York -l!PU- The Tren
delenberg position is neither
a wrestling technique nor a
chess gambit,
but a posture
which sur
geons have
long favored
for certain pa-
. , ... ,
y, t Vl i n e n i a ana
I 1 V ' which now is
I 1." LJ- f 'under scien-
i tine attack
,-4 after some 70
y e a r s of re
spectability. When you have
been Trendelenberged your
feet are higher than your head
is - you're lying down but
you're tilted 43 degrees off
8,
Uiloi smith
the horizontal. This is the
heads-down position taught in
medical schools and even to
lay-people taking first - aid
courses.
It is supposed to help the
body to stave off the life
threatening consequences of a
suddenly lowered blood pres
sure and of shock in general.
The attacker is Dr. Max H.
Weil of the University of
Southern California, Los An
geles, who has devoted years
to the study of shock.
He and his research asso
ciates titlted scores of mice
and rats, since you can not
properly subject people to
such an indignity without
reason. These animals were
required to live for 48 hours
with their heads either ele
vated or lowered from the
horizontal, to demonstarte
that in normal circumstances
neither position did any harm
to rodent health
Then the scientists imposed
physiological shock on them,
with suddenly lowered blood
pressure and the other ill con
sequences. The scientists did
it by injecting various sub
stances. One was a normal
body chemical which is in
volved in massive allergic
shock. Another was a bac
terial poison which also
causes shock In people. A
third was a sedative that in
overdoses is fatal.
The idea was to find out
which rodents withstood
shock best - those with heads
down, those with heads up or
those who were in the true
horizontal. The horizontals
fared the best by a wide
margin. In Weil's words, the
alleged helpfulness of the
Trendelenberg position "was
excluded with very high sta
tistical confidence."
In his report to the Ameri
can College of Surgeons, he
said Trendelenberging might
effectively restore conscious
ness to a person who had
fainted or it could be useful
in the first moments of shock
following the loss of blood. It
will usually cause a small in
crease in blood pressure but
only because the arms are
lower than the heart, he said.
But in patients with pro
longed lowered blood pressure
it may well delay recovery, he
said. It prevents a return of
normal reflexes and the con
tents of the abdominal cavity
fall against the diaphragm
and decrease lung volume.
The Trendelenberg position
was Improvised by the cele
brated 19th century German
Surgeon, Dr. Friedrich Tren
delenberg (1844-1924) to fa
cilitate certain surgical pro
cedures. During World War I
it came into widespread use
as a means of combatting sur
gical shock.
It is reasoned that when
the head is down venous blood
returns more rapidly to the
heart and there may be better
blood flow to the brain. "To
our knowledge such effects
have not been demonstarted,"
Weil commented.
The science of surgery
should re-evaluate Trendelen
berging completely because
"its prolonged use is not
necessarily associated with in
creased survival but may, in
fact, be detrimental."
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