To the Editor.–In his report on the management of adynamic ileus of the colon (Arch Surg 109:503, 1974), Dr. Adams notes that, among his 20 patients, maximal distention was invariably segmental with an apparently abrupt "cutoff" of the more severely distended proximal part of the colon. The only possible explanation for this situation, in the absence of organic obturation or extrinsic compression, would be a kink or local spasm of the bowel. The fact that in every case the location of the "cutoff" was at one of the major bowel flexures, and the ease with which contrast agent administered under pressure in retrograde fashion flowed through the "cutoff" point, strongly suggest a kink due to overdistention.
It would appear, therefore, that the basic objective of management in such cases is prompt decompression of the proximal part of the dilated segment.
An ordinary rectal tube would rarely be long enough