Original article| Volume 6, ISSUE 5, P569-578, May 1929

What has happened to the unobstructed bowel that fails to transport fluids & gas?

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      The digestive tract is highly autonomous and the extrinsic nerves serve largely to prevent response to every stimulus. After vagotomy or splanchnicotomy peristalsis is often so active that the animal dies of inanition.
      Normal aborad peristalsis appears to follow gradients of rhythmicity, irritability, latent period, metabolism, and muscular strength, running from duodenum to terminal ileum. These gradients might theoretically be reversed either by raising the irritability of the lower end of the gut or by depressing that of the upper end.
      It may perhaps be stated as a law that irritation at any point in the bowel tends to slow the progress of material coming from the stomach toward it, and to hasten the progress of material moving caudad away from it. If the irritation is severe enough the result is an emptying of the digestive tract both ways from the lesion, with vomiting and diarrhea.
      When, in rabbits, enough turpentine was injected into the tissues about the ileocecal sphincter to produce considerable injury, the animals suffered from diarrhea and the colon was emptied. The ileum was emptied orad and food residues were held back in the duodenum. Peristaltic rushes were few; they were hard to start, and they were slowed and stopped in the lower bowel.
      The whole bowel was unusually sensitive to faradic stimuli, and in most of the experiments the normal gradient in irritability from duodenum to ileum was reversed. With the increased irritability of the bowel the latent periods were shortened, and the fact that this change was more marked in the lower ileum than in the duodenum caused the normal gradient (in latent period) to be flattened.
      Segments of gut excised from the injured animals and placed in warm aerated Locke's solution behaved normally, showing that the failure of the bowel to pass onward its contents was not due to injury to the muscle.
      Chemical injury to the ileocecal region in animals with vagi and splanchnics cut and much of the conducting system in the bowel degenerated still produced backpressure in the small bowel and marked slowing of rush waves. This suggests that the flattening of gradients had something to do with the failure of conduction.
      The work suggests that in treating dynamic ileus attempts should be made first, to remove nervous inhibition, perhaps by splanchnic blocking or by spinal anesthesia, and second, to restore the normal dynamic gradient by giving food, and by avoiding morphine and irritation to the lower bowel. The various methods of inducing peristalsis postoperatively are briefly reviewed.
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