J.Jpn. Surg. Soc.. 55(7): 662-675, 1954

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宿題報告

Ileus (With an especial reference to intestinal movements)

The physiology and the pathophysiology of the intestinal movements during ileus of different types were studied by the oscillographic recording of the borborygmus, by observing the movements through abdominal windows, in Thiry-Vella loops and Biehle loops, by tracing the internal pressure of the intestine, by observing the movements of supravital intestine, and by tracing action current from the intestine.
The kinds of intestinal movements noted in normal intestines were three fundamental rhythmic movements -peristalsis, segmental movents and pendular movements- and waves of tonus variation, while those noted in obstructed intestines were movements indicative of dwindled fundamental rhythmic movements and tonus variation abnormalized, i.e., strong tonic rise (or sometimes spasm) and deep drop alternating at long periodicity. This alternating types of movements characteristic of an intestine with ileus was called vicisitudinous type by the author. Electrophysiological, studies have shown that each single fundamental rhythm of a normal intestine corresponds to a mixture of a spike group and an accompanying slow wave. It has been disclosed that in a pathological condition like that of ileus, in which a strong intestinal contraction occurring is recorded as a large periodic wave on the mechanogram, spikes of action current from the intestine are small in size and number, showing that strong intestinal contraction in ileus is contraction caused without any normal spike excitation evoked. The fact signifies in other words that intestinal contraction in ileus is undoubtedly pathologic in that it is a view of an abnormally intensified tonic factor of movement which is little concerned in spikes. Such an abnormal movement, a movement of vicissitudinous type, may be due to the worsened environment of the muscle cells, probably with various factors involved. The relations between spaom and gases (H₂S and CO₂ for instance) produced by intra-luminal decomposition and fermentation, the K content of mesenterial venous blood, the cholinesterase content of blood and the Schultz-Dale reaction were investigated. Serious degeneration of the intramural nerve plexus of the intestine, observable closely above and below the site of obstruction but reduced at the bowel apart far from the obstruction appears to be concerned with spasm in some way. The abnormal movements of the intestinal muscle layers as presented in supravital specimens show that apasm, occurring above and below the site of obstrucrtion, is milder at the area of the occurrence is remoter from the site. The fact is of interest in that it occurs with the above stated histological findings. The normal course is that an abnormally high intraluminal pressure occurring in the area just above the site of obstruction causes inhibibition of movement in other parts of the intestine. Whereas the inhibition of movement, even far apart above the obstruction, becomes apparently insignificant, if the previously inhibited part becomes secondarly distended because of the wide spreading stagnation.
In such way, when the distention above the site of obstruction becomes extended over a wide area, movements of vicissitudinous type are started synchronoulsy along the entire length of the distended area.
The intestinal movements during ileus give off a thundering sound intercepted by a period of silence at regular intervals, exactly concurring in periodicity with the movements of vicissitudinous type traceable by the mechanograph.
This alternation of silence and a rumble in the sounds of intestinal movements which is recognizable by auscultation at many parts of the abdominal wall, is explicable by the above-described synchronization of movements. The abnormal intestnal movements during ileus persist four, five or even seven days after removal of the obstructing cause and badly impede the conveyance of the contents in the meantime. Histological examination shows that changes in the nerves of intestine also remain unrepaired for a long time after surgical removal of the obstructing cause. Even in cases in which the obstructed portion is resected and the cut ends are anastomosed, the movement of thus repaired intestine is very abnormal equally for a long time and healing of the anastomosed ends is far less satisfactory in the intestine than in a control. Such postoperative retardation of the recovery of the intestinal movements constitutes a serious clinical problem. It seems necessary that greater attention must be directed to the intestinal blood circulation to speed up the recovery of the intestinal movements after removal of the obstructing cause.
(author's abstract)

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