What is short circuiting of the colon?
Short
Circuiting of the Colon
Q. What is short circuiting of the colon?
A. In short circuiting of the colon,
the small intestine is detached from
its normal connection with the colon and is connected
with the pelvic colon, the loop of
the large intestine which joins the rectum.
This operation, devised by Dr. Lane of
London, has been performed in many cases for the purpose of relieving intestinal toxemia or chronic
constipation, and in some cases with
apparent benefit, but unfortunately
the benefit has in most cases proved to be only temporary and in many instances
the patient has been made much worse than before. The operation is rapidly
falling into disfavor among the best
surgeons. Later experience has shown that
the operation is rarely necessary for the following reasons
:
1. By regulation of
the diet, especially by the adoption of an
anti-toxic or fleshless diet and by encouraging activity of the bowels through the use
of sterilized bran, agar-agar and
paraffin oil, constipation and intestinal
toxemia can be successfully
combatted in a large proportion of the
cases in which the operation of short circuiting
has been thought to be necessary. This has been
demonstrated in a very extensive way at the Battle Creek Sanitarium
and other institutions in which the dietetic and
other measures for correcting the intestinal toxemia have been employed in a thoroughgoing way. Combe has obtained
like successful results by non-surgical means.
2. Observations by Dr. J. T. Case, roentgenologist of
the Battle Creek Sanitarium, and clinical
observations by the writer and his
associates have clearly demonstrated that the so-called Lane's kink or
adhesions of the small intestine near its
point of junction with the colon is not the cause
of the intestinal toxemia
which Doctor Lane has considered to be an indication for the performance
of the operation of short circuiting.
It has been shown instead that the toxemia which is
caused by the retention of foodstuffs in the
small intestine is not due to an obstruction by a kink, but to a reflux or backing up of
decomposing material from the colon because of incompetency of the ileocecal valve. What these cases really
need then is not short circuiting, but simply repair of the ileocecal valve. The
correctness of this view
has been established by the performance
of this operation in more than two hundred cases with
complete success in nearly every case. By repair
of the valve the
so-called "ileac stasis" is cured and the former symptoms
of toxemia, headaches, loss of appetite,
coated tongue, foul breath, pigmentation of the skin, and other symptoms of chronic toxemia have been made to rapidly disappear.
3. The operation of short circuiting cannot succeed
permanently for the reason that the new point of junction between the small
intestine and the colon is not protected by the valve which is normally found
at the ileocolic junction, and the consequence is, after a few months fecal matters
back up into the small intestine, many feet of
which become distended with fecal matters, thus
the patient is even worse off than before the
operation. Whenever an operation for
transplanting the small intestine to another part of the colon is performed, an
artificial ileocecal valve should be made so
that the opening may be properly guarded.