J.Jpn. Surg. Soc.. 54(9): 798-807, 1953

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Original article

STUDY OF THE INTESTINAL ADHESION, ESPECIALLY ESSENCE OF POST-OPERATIVE ABDOMINAL NEUROSIS

Problem of post-operative intestinal adhesion has been studied chiefly in relation to the queslion of passage disturbance of the intestinal canal or of adhesive ileus, but as to the mechanism of such adhesions very little work has been reported condition of the functional obstruction without mechanical disturbances of this nature has been called "Abdominal Neurosis" by Prof. Araki.
Recently the author have made some clinical and experimental observations on cases of post-operative disturbance in intestinal function, results of which are presented in this report.
1. Mechanism of formation of intestinal adhesion
The nature of intestinal adhesion following application of chemical and physical stimulius was observed following 30 to 240 minutes after operation.
It was found that the process of adhesion appeared after 30 minutes already, and fibrous adhesion occurred within 120 minutes.
Histologically, the serosa showed necrosis, the muscularis and the submucous layer becoming edematous. The edema fluid escaped to the serosal surface and acted as an adherent medium. Thereafter, evidence of repair was seen, and in the course of 6 to 12 months following operation, the involved intestine showed granulation and cicatrization and even the picture of chronic inflammation.
These changes occurred whether the stimulus applied was chemical or physical but they were noted only when the chemical or physical, but they were noted only when the chemical agents were coagulative or permeable in thier action.
Thus, it was inferred that for producing the disturbance in intestinal tunction, especially the nervous disturbance, it was necessary that, in addition to the changes in the serosal surface, the alteration in other layers except the mucosa must be present.
2. The nature of abdominal neurosis.
Clinically patient shows very little mechanical obstruction in spite of violent symptoms of ilcus, and roentgenological examination reveals lack of correlation between the gastric, intestinal and colonic movements.
The vegetative nervous system shows chiefly parasympathicotonia or else the hypertonia of both sympathetic and parasympathetic systems.
Therapy of these patients usually brought about good results by operative removal of the carotid body which restituierened the normal intestinal movement and vegetative nervous function.
It was further observed that the blood cholin content in these patients showed and increase, and that the action current was identical to that seen after use of parasympathi costimulus.
The histochemical test for cholin was positive in the above-mentioned histological section and at the location of the adhesion .
From these findings it is result of parasympatheticotonia together with other constitutional nervous factors, in addition to such local factors as maladiustment of intestinal movements brought about reflexly by abnormal stimulus arising from nervous disturbances at the location of adhesion. (author's abstract)

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