Causes: overdistensions in front of obstructions, softening,
friability, necrosis, suppuration or ulceration, Duodenum from worms
or perforation by pointed bodies, exudate in verminous embolism,
petechial fever. Jejunum and ileum, by disease of walls, ulcers,
abscesses, neoplasms, caustics in umbilical hernia, clamping of
hernia. Cæcum, falls, blows, kicks, blows of horn, tusk, stump,
calculi, abscesses, cauterizing of hernia. Colon, external traumas,
calculi, worms, verminous thrombosis, neoplasms, abscesses,
overdistensions, violent straining, arsenic. Symptoms: follow
accident, signs of obstruction, no rumbling, tympany, stiffness, great
prostration, fever. Death in short time.
_Causes._ Ruptures occur as we have already seen from overdistensions of
the bowel in front of some obstruction, by ingesta, concretions,
calculi, foreign bodies, etc., and this may take place in the most
healthy organs. In other cases, however, there has been some
pathological process at work rendering the intestinal wall soft,
friable, necrotic, suppurative or ulcerative, by which its substance is
attenuated or its consistency or cohesion reduced.
=Duodenum.= Lacerations of the duodenum are often connected with
obstruction by tumors or the ravages of worms. These latter are mostly
the ascaris megalocephala, accumulated in mass, and sometimes engaged in
pouches outside the walls of the gut. In other cases, the walls of the
intestine have been perforated by hard woody stalks of straw or hay
(Mollereau) or of still more woody plants as in a case observed by the
author, and in which the pylorus was perforated. Sometimes the exudate
or blood extravasation attending on petechial fever, or verminous
embolism will pave the way for the rupture. Perforations by pieces of
wire (Schmidt) or other metallic bodies are also observed. Adhesive
peritonitis has also rendered the walls friable and predisposed to
rupture.
=Jejunum and Ileum.= Lesions are most frequent toward the termination of
the ileum and resulting from obstructions of the bowel or the weakening
of the walls by disease, or both. Ulcerations, abscess of the closed
follicles opening into the peritoneum, and neoplasms of various kinds
are to be especially noted among the causes. The impaction of the cæcum,
blocking the ileo-cæcal valve is also among the observed factors. Other
instances have been traced to deep cauterization of an umbilical hernia,
the enclosed loop of small intestine becoming inflamed and perforated.
The author has observed one instance from clamping of a hernia in which
the contained intestine was adherent to the hernial sac.
=Cæcum.= From its position on the lower part of the abdomen and from its
habitual plenitude with food or water, this organ is especially exposed
to direct mechanical injuries and ruptures. A sudden fall, more
especially if the umbilical region strikes on a stone or other
projecting solid body, kicks with heavy boots or with the feet of other
animals, blows with a cow’s horn or a boar’s tusks, and violent contact
with stumps, poles and other objects may be the occasion of the rupture.
These are usually found near the base of the viscus and across its
longitudinal direction.
Inflammations, connected with punctures, calculi, parasites, etc., may
render the walls so friable that they give way under slight strain or
injury. Abscesses have been found in the walls of the viscus leading to
perforation, and extension of inflammation from an umbilicus cauterized
for hernia has determined adhesion and perforation.
=Colon.= The loaded colon is even more liable to mechanical injury than
the cæcum. Occupying as it does the more lateral parts of the abdominal
floor, it is even more exposed to kicks and blows, and extending as it
does back toward the inguinal regions, it is especially in the way of
blows of horns so often delivered in this region. From the solid nature
of its contents the presence of calculi, the presence of blood sucking
worms, and its implication in the congestions and extravasations of
verminous thrombosis, this organ is especially liable to degenerations
and inflammations which render its walls particularly friable. Neoplasms
of various kinds, cancerous, tubercular, etc., have been found on its
walls as occasions of rupture. Abscesses of strangles have ruptured into
the viscus. Overdistensions in front of an obstruction in the pelvic
flexure, floating colon or rectum are the most frequent causes of
rupture. Again, cases have been seen as the result of violent exertions,
as during straining in dystokia. It has been a complication of phrenic
hernia, of volvulus of the double colon, and of ulceration caused by the
prolonged ingestion of arsenic. In severe impaction the necrosis of the
intestinal walls has proved a direct cause of laceration. The seat of
these ruptures may be at any point, but it is most frequent in front of
the pelvic flexure, or in the floating colon, or directly in the seat of
impaction.
_Symptoms._ The attack comes on suddenly, perhaps in connection with
some special accident or injury, and is manifested by violent colicy
pains which show no complete intermission. In many respects the symptoms
resemble those of complete obstruction of the bowel, there is a
suspension of peristalsis, rumbling, and defecation, a tendency to roll
on the back and sit on the haunches, an oblivion of his surroundings and
pain on pressing the abdomen. Usually the shock is marked in the dilated
pupil, the weak or imperceptible pulse, the short, rapid breathing, cold
ears, nose and limbs and the free perspirations. Tympany is usually
present as the result of fermentation. Signs of infective peritonitis
and auto-intoxication are shown in the extreme prostration, unsteady
gait, dullness and stupor, and general symptoms of collapse. The
temperature, at first normal, may rise to 105° or 106° as inflammation
sets in, and may drop again prior to death.
_Termination_ is fatal either by shock or by the resulting peritonitis
and auto-intoxication. Exceptions may exist in case of adhesion of the
diseased intestine to the walls of the abdomen and the formation of a
fistula without implication of the peritoneum.