Dilatation of the Colon.
Definition:—Dilatation of the colon is a condition in which this organ is enormously distended, and may be accompanied by either stretching and thinning, or hypertrophy of its walls.
Etiology:—Four classes of cases are recognized: (a) Dilatation due to accumulation of gas; this is an acute form, sometimes met with in acute infectious diseases, as typhoid fever and the pneumonia of alcoholics, (b) Dilatation from the accumulation of foreign bodies, as gall stones and enteroliths, a very rare condition in the human subject, (c) Dilatation due to obstruction of the lower part of the colon by stricture, neoplasms, especially carcinoma, or by volvulus and bands of adhesions, (d) The cases of so so-called idiopathic dilatation, seen but rarely, and due to a congenital narrowing of the lower part of the bowel.
Symptomatology:—In acute gaseous dilatation there is abdominal distention with tympany. The diaphragm is pressed upward, interfering with the action of the heart and lungs. It is an evidence of functional inability on the part of the intestine, and thus of a condition of lowered vitality. In the other types there are constipation, accumulation of fecal masses, attacks of colic, and frequently ulceration.
The abdomen may be very tender to the touch, especially over the hepatic and splenic flexures of the colon. Nausea and vomiting may be so established that the taking of any kind of food or drink is attended with difficulty.
Diagnosis:—The diagnosis is made by the presence of bulging and tympany over the course of the colon in acute cases, and tenderness and fecal accumulations, together with the passage of enteroliths, particles of blood and shreds of tissue in other cases, and by proctoscopic examination.
Prognosis:—The prognosis in acute cases is that of the disease underlying the condition, though the relief of the gaseous accumulation is distinctly favorable to the relief of the causative disease.
In chronic cases the prognosis depends upon the possibility of establishing an artificial anus above the constriction.
Treatment:—In that form due to the accumulation of gas it is necessary, first, to remove the gas, and secondly, to adopt measures which will retard its accumulation. Any constipation that may be present must first be overcome by proper measures. The introduction of an emulsion of turpentine, prepared in such a mannner that the entire quantity used shall contain from twenty to forty minims of the oil, thoroughly mixed with a gum-arabic mucilage, or with the milk of assafetida, will be found serviceable. The bowel may be relaxed by the compound tincture of lobelia and capsicum. If there is tendency to muscular spasm, a hot bath sometimes materially assists in the removal of the gas. Experience has proven that puncture of the abdominal and intestinal walls with a needle, in order to permit the direct escape of the gas, is not a practicable measure. The conditions underlying the gaseous accumulation and intestinal inactivity should be treated with those remedies which appear to be directly indicated.
The other conditions of intestinal distention, such as the presence of foreign bodies, or congenital occlusion of the canal, are surgical in character, and will usually demand an operation.
