STINAL OBSTRUCTION.--Causes.--This may be caused by strangulation,
telescope (intussusception) of the bowels, twists and knots, strictures
and tumors, abnormal contents.

1. Strangulation is the most frequent cause; this is caused by adhesions
and bands from former peritonitis, or following operations. The
strangulation may be recent and due to adhesion of the bowels to the
abdominal cut or wound, or a coil of the bowel may be caught between the
pedicle of a tumor and the wall of the pelvis. These cases are rather
common after some operations.

2. Intussusception.--This means that one portion of the bowel slips into
an adjacent portion. These two portions make a cylindrical lump varying in
length from one-half inch to a foot or more. Irregular worm-like motion of
the bowel is a cause of intussusception.

3. Twists and knots.--Most frequent between thirty and forty. (There is an
unusually long mesentery.)

4. Strictures and tumors.--These are not very important causes.

5. Abnormal contents.--Fruit stones, coins, pins, needles, false teeth,
round worms rolled in a mass. Coins rarely cause inconvenience.

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Symptoms of Acute Obstruction.--Constipation, pain in the bowels, and
vomiting are the three most important symptoms. Pain sets in early, and
may come on abruptly when walking or more commonly when working. It is at
first colicky, but soon becomes continuous and very intense, vomiting soon
follows and is constant and very distressing. First the stomach contents
are vomited, and the greenish bile-stained material, and soon the material
vomited is a brownish-black liquid, with a bowel odor. This peculiar
vomiting is a very characteristic symptom. Constipation may be absolute,
without the discharge of either feces or gas. Very often the contents of
the bowel below the obstruction are discharged. The abdomen is usually
distended and when the large bowel is involved this is extreme. If it is
high up in the small intestine, it may be very slight. At first, the
abdomen is not tender, but later it becomes very sensitive and tender. The
face is pale and anxious and finally collapse symptoms intervene. The eyes
are sunken, the features look pinched and a cold, clammy sweat covers the
skin. The pulse becomes rapid and weak. There may be no fever, and it may
go below normal. The tongue is dry, parched, and the thirst is incessant.

Recovery.--The case terminates as a rule in death in three to six days