Definition: rolling of a loop on its mesenteric axis, bending in a
vicious direction, rolling of one loop round another. Causes: laxity
of mesentery in hernia, relaxation or rupture of linea alba, pot belly
in old breeding mares, sudden movements in falls, leaps, draught,
galop, slipping, mounting, warm weather, casting, rolling, rising,
sudden filling of a loop, heavy feeding and fermentescible food, cold
drinks, chills. Lesions, most in double colon, next in jejunum, cæcum
wrapped in small intestine, floating colon, tympany and pallor of
obstructed loops, later congestion, infiltration, extravasation,
adhesions, necrosis, sloughs, infective peritonitis. Symptoms: sudden
severe attack, violent, reckless colicy movements, pain constant with
exacerbations, fever, prostration, collapse. Diagnosis: only by rectal
exploration and exceptionally. Treatment: by rectal manipulation,
eserine, castor oil, laparotomy.
Strictly speaking this lesion consists in the twisting of a loop of
intestine upon its mesenteric axis, so that the portion which is drawn
spirally over the mesentery of the other is more or less completely
obstructed. The term has, however, been applied as well to the turning
of a viscus at a sharp angle from its normal direction so as to
interfere more or less with the passage of its contents and with its
circulation. This has been especially seen in a vicious direction given
to the cæcum, but also at times to the double colon. The simple twisting
on the mesenteric axis is common to the floating portion of the small
intestines, the double colon, floating colon and rectum. A third form of
twisting which is, however, rather a strangulation, consists in the
rolling of one loop of intestine round the loop of another, the
mesentery of which has become unduly long.
_Causes._ The predisposing cause is a certain laxity or undue
lengthening of the mesenteric attachment of the intestine. This is
sometimes formed in connection with the existence of hernia, into which
the bowel protrudes, or short of this a relaxation or rupture of the
linea alba so that the whole of the intestinal mass hangs down unduly,
or finally in unthrifty pot-bellied animals and in breeding mares in
which the abdomen is unduly pendent.
Next comes the question of sudden movement as in falls, in leaping, in
violent exertions of draught, or galop, in sudden slipping upon wet or
icy ground, and of stallions in mounting mares. In the Omnibus Company’s
(Paris) horses Palat found 35 cases in entire horses, 23 in mares, and
11 in geldings. The stallions in the stables were fewer than the mares
and geldings put together, but it does not appear that the difference
was sufficient to make the above figures very significant. These
stallions it should be added, are not used for breeding, so that the
statistics have no bearing on the effect of mounting.
Palat’s figures show a greater number of cases in summer, than in
winter. There were 58 cases from April to October and but 21 from
November to March. It would seem as if the relaxation of the system and
mesentery in summer more than counterbalanced the combined effect of
slipping on ice and sudden chills.
A large proportion of the cases have been found in horses that have died
of colic, or which have been cast for operation, and the recent
character of the lesions has often shown that we must look upon them as
the result of the tumultuous peristalsis, and the lying, rolling,
sitting and other sudden and unwonted movements performed. A heavily
loaded portion of bowel, occupying a position slightly lower than a
lighter portion or parallel to it, suddenly moves by gravitation when
their relative positions are altered as in rolling, decubitus, or
rising, and it thereby becomes twisted upon itself. Or a portion of
intestine filled with liquid or gaseous contents is suddenly emptied by
the passage of these onward into another and the latter portion of
intestine or some other lodged alongside it, in moving to fill the
place, rotates upon itself and establishes a volvulus.
Hard worked horses which are subjected to stimulating feeding are much
more frequently attacked than those which have light work and feeding.
In the same way newly harvested hay or oats, spoiled or otherwise
indigestible food have apparently been productive causes. Cold drinks,
and exposure to cold draughts have been similarly charged. Indeed any
cause of indigestion and colic may be held to predispose to volvulus.
_Lesions._ _Seat._ Twisting of the small intestine is impossible in the
duodenum, and for the floating portion it is far more common in the
ileum and terminal portion of the jejunum where the mesentery is long
than in the anterior jejunum where it is short.
The double colon from the sternal portion to the pelvic flexure being
free from any restraint by omental or mesenteric bands is especially
liable to torsion. Palat found four cases of torsion of the colon to one
of the small intestine, and Schutze gives the ratio as 56 of the first
to 13 of the second.
The cæcum has been frequently found twisted upon itself with a portion
of the small intestine rolled round it.
The floating colon like the small intestine is rolled around its
mesenteric axis, but cases are much more rare than in the case of the
small intestine.
In a recent and complete twisting with obstruction of the bowel, the
loop of intestine is distended with gas the result of fermentation of
its contents, and its walls may be thin and pale. Much more commonly and
when the lesion is of longer standing there is hyperæmia, and
infiltration and thickening with inflammatory products, and blood
extravasations. At the seat of torsion the compressed intestine is
congested, covered with petechiæ, and its peritoneal surface with
fibrinous exudate tending to bind the parts together. Later there may be
seen spots of necrosis and perforating sores and semi-detached sloughs,
or the whole mass of twisted bowel may be gangrenous. The patient
usually dies before this last stage has been reached. If the animal
survives long enough the lesions of infective peritonitis are constantly
present.
_Symptoms._ The disease usually sets in suddenly with intense severity.
In exceptional cases there is an insidious onset, the twist being at
first but partial and gradually increasing and for a time the contents
pass on in a restricted but still physiological manner. Colics at first
slight become by degrees more and more intense until all the symptoms of
obstruction and acute inflammation are developed.
More commonly symptoms of extreme gravity appear at once, the patient
stops, paws, kicks at his belly, tries to lie down, strains to defecate
or urinate, lies down, rolls, sits, gets up and moves round uneasily
trying to lie down again. He looks at the flank with anxious eye and
countenance and has all indications of the most violent colic. Pain is
constant, but worse at one time than another, the pulse is from 50 to 90
and becomes weak and even imperceptible as the case advances, and
hyperthermia, at first slight or absent rises with the onset of
inflammation. Finally great prostration, depression and stupor, sunken,
glazed eye with dilated pupil, and cold sweats and extremities bespeak
collapse or general infection.
_Diagnosis_ is rarely certain. The sudden onset, extreme violence of the
symptoms, and rapidly fatal progress are significant and in exceptional
cases rectal exploration will detect obstruction in the rectum or
floating colon, or a tympanitic condition of the pelvic flexure.
_Treatment._ A rational treatment is only possible in those rare cases
in which the diagnosis is certain. When the lesion can be reached in the
rectum or adjacent part of the floating colon, the oiled hand may be
made to drag on the interior of the viscus so as to restore it to its
normal position.
Cadiot has had recoveries from supposed volvulus by the use of eserine
hypodermically, and Trasbot by the use of castor oil and it is just
possible that active peristalsis, and plenitude of the bowel running
into the volvulus, may serve to unwind slight cases. When the diagnosis
is certain and the case, as usual, intractable the resort of laparotomy
and the attempt at untwisting is fully warranted. The case is a fatal
one if unrelieved.