. Surgery, its principles and practice . hologic consequences in the bowel wall. Arnd showedthat in strangulated hernia the circulatory disturbances permit micro-organisms to pass into and even through the intestinal wall. General 644 SURGERY OF THE INTESTINES. intoxication naturally occurs as a result of the resorption of ferments,etc. Just as is the case in strangulated hernia, so in intestinal obstruc-tion, quantities of fluid are poured into the intestine from the mucousmembrane, partly from hypersecretion, partly from inflammatory exuda-tion, and partly from hemorrhage. The fermentation o
. Surgery, its principles and practice . hologic consequences in the bowel wall. Arnd showedthat in strangulated hernia the circulatory disturbances permit micro-organisms to pass into and even through the intestinal wall. General 644 SURGERY OF THE INTESTINES. intoxication naturally occurs as a result of the resorption of ferments,etc. Just as is the case in strangulated hernia, so in intestinal obstruc-tion, quantities of fluid are poured into the intestine from the mucousmembrane, partly from hypersecretion, partly from inflammatory exuda-tion, and partly from hemorrhage. The fermentation of all of this ma-terial together with the venous stasis may result in the destruction ofthe intestinal epithelium. Circumscribed necroses take place, the mucousmembrane and underlying tissues are cast off, especially where venousstasis has led to ecchymoses, and the ulcers may even perforate, to theproduction of peritonitis. Kocher thinks that the importance of theselesions has not been sufficiently recognized. Certainly surgeons should. Fig. 352.—Twenty-four Inches of Small Intestine Resected for Chronic Coprostasis AND Obstruction due to Post-operative Ventral Hernia and large coprolith is seen through the incision in the intestinal wall. A piece of skin was removed before the hernia was closed. be familiar with the fact that the bowel above the point of obstructionis not in a normal condition, and in operative treatment should be gov-erned accordingly. Kocher considers that the most important point inthe treatment of obstruction is the drainage of the bowel above thelesion. Intestinal occlusion may be caused by malformation of the bowel(atresia, Meckels diverticula) or of its mesentery, by peculiarities of theabdominal wall, the peritoneum, the omentum, or the diaphragm, or byundescended testis; by diseases of the intestinal wall, as scars or tumors;by inflammatory processes; by the results of traumatism, operative orotherwise; by abnormal intestinal contents;
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