ACUTE intestinal obstruction is a medical emergency requiring prompt diagnosis and treatment. Time is an important factor in this condition and without relief, ileus, with its vicious cycle, may develop. With the advent of the roentgen examination and its subsequent improvement in technic for visualization of the gastrointestinal tract, extensive strides have been made in the diagnosis of intestinal obstruction. This procedure may be employed, not only as a means of diagnosis, but also for localization of the site of the lesion and its possible cause. Having ascertained the approximate location, the surgeon may better plan his approach for alleviation of the condition.
There are, of course numerous causes for an acute obstruction, the most common comprising peritoneal adhesions from previous inflammatory disease or operation. Among other causes, in diminishing frequency, are neoplasm, intussusception, volvulus and impaction of gallstones. The latter is somewhat uncommon and found to be present in less than 2 per cent of all acute intestinal obstructions. History of previous biliary disease is suggestive but definite diagnosis and localization may be made in most instances by the roentgen examination.
A 67 year old widow entered the Cleveland Clinic March 8, 1948, complaining of vomiting and inability to eat. The patient had been well until July 1947 when she suddenly contracted severe pain in the right upper abdomen and flank which seemed to travel downward toward the right hip and was accompanied by vomiting. This condition persisted for two days with additional symptoms of weakness and. . .