Diseases of the intestines, their special pathology, diagnosis, and treatment : with sections on anatomy and physiology, microscopic and chemic examination of the intestinal contents, secretions, feces and urine intestinal bacteria and parasites; surgery of the intestines; dietetics, diseases of the rectum, etc / by John C. Hemmeter.

  • Hemmeter, John C. (John Conrad), 1863-1931
Date:
1902
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Licence: In copyright

Credit: Diseases of the intestines, their special pathology, diagnosis, and treatment : with sections on anatomy and physiology, microscopic and chemic examination of the intestinal contents, secretions, feces and urine intestinal bacteria and parasites; surgery of the intestines; dietetics, diseases of the rectum, etc / by John C. Hemmeter. Source: Wellcome Collection.

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    SIGNS OF VON WAHL AND SCHLANGE. of the cecum as it would be for occlusion of the sigmoid, etc.). If the patient can state exactly where the initial pain was felt in his abdomen, or is still felt, and also if this pain does not increase under pressure, but rather decreases, the discovery of the seat of the occlusion has been furthered by one essential factor. Circumscribed pains which are felt later on can not be utilized at all, or but little, in the determination of the occlusion. Unfortunately, in only a portion of the cases—namely, in the strangulations—is the pain felt at the seat of the occlusion. In the cases due to chronic intestinal stenosis this is hardly ever the case, and in the others the pain is either transferred to the umbilical region or is diffuse from the very start. Another important guide to the location of the intestinal occlusion is the inflated intestinal loop, which extends to the place of occlu- sion, and by which the abdominal wall is moderately bulged out asymmetrically. This is von Wahl’s symptom. And I must not omit to emphasize again that this loop is motionless; there is no peristaltic contraction in it (the so-called fixed, motionless, inflated loop of von Wahl). The percussion sound over this loop is not the ordinary intestinal tympanitic resonance, but a deep, non-tympanitic sound. According to Schlange, a suppressed slight peristalsis can be observed in the suprastenotic loop before it comes to complete rest (the so-called distended fixed loop with peristalsis of Schlange). This clinician, and also Naunyn, regards this sign as valuable for the diagnosis of acute occlusion and the locality of it. The slight peristalsis referred to must not be confounded with the stormy con- tractions that always run in a direction toward the occlusion, and which are found only after chronic stenosis when hypertrophy of the muscular walls has developed. In the acute occlusions that have come under my observation, I was unable to detect Schlange’s peristalsis; and I am disposed to believe that even if it occurs, it must be of such short duration that it has ceased before the physi- cian sees the case. By the time cases of acute occlusion are seen by the physician, the pre- or suprastenotic loop, if distinguishable, is in a state of quiescence. If the peristaltic movements, which are usually combined with more or less severe pains, also proceed in a definite direction, one may assume with certainty that the occlusion is in the