ACUTE OBSTRUCTION OF THE SMALL INTESTINE

THE THERAPY of intestinal obstruction has become somewhat confused in the minds of many surgeons in recent years. The introduction of the long nasogastrointestinal tubes plus widespread use of antibiotics has produced a temporary improvement in the patients' condition that is often dangerously misleading to the clinician. Thus corrective surgery has been delayed to an extent that failure often results. In an attempt to clarify the situation as we see it at this time, I will set down some of the basic principles involved, with the hope that they will be helpful.

Paralytic ileus was common in the days when peritonitis was prevalent. Now it is infrequent and should not be confused with mechanical obstruction. There is always a physiologic ileus following laparotomy, the degree and duration of which is dependent on the amount of necessary manipulation of the small bowel. Even in extensive abdominal procedures, peristalsis returns to normal