Infection Of The Small Intestine From The Colon

The ileo-cecal valve, the organ of defense against infection of the small from the large intestine, stopping the back flow of the latter, has been carefully studied only within recent years and the principal honors in connection with such study belong to Case. Fortunately an impaired valve has not been found to be irremediable. If the abdomen is opened in any other operation an injured valve is easily repaired. Without this simple surgical operation much can be accomplished by hygiene and a correct diet.

Case reported in 1912 that out of a series of 200 consecutive gastro-intestinal cases, many of them constipated, one-sixth showed incompetency of the ileo-cecal valve as shown by a barium enema. In 1913 in a series of 1500 cases there were more than 250 cases of incompetent ileo – cecal valves. Case further observes that he has often noted that the small intestine has been empty at the 12th hour, all the contents having passed into the colon after a bismuth meal, yet observation the next morning showed bismuth back again in the terminal ileum (last part of the small intestine), no fresh bismuth meal having been taken in the interval. In every instance where the ileo-cecal valve proved in-competent to the enema, the surgeon at the operation found gas or fluid distension of the terminal ileum, often to a distressing degree in spite of thorough efforts at pre-operative bowel cleansing. Wherever the ileo-colic (ileocecal) valve has proved ‘competent to the enema the surgeon has in a great majority of cases found it so.

Still further proof of the normal competency of the valve is found in the fact that the incompetency found at operation has been cured in a number of cases by a simple surgical procedure.

Referring to Kellogg’s more recent publications on this subject he does not recommend opening the abdomen for the repair of the valve, although the operation is not a difficult one. He says that when the valve is defective reverse movements force the liquid food residues in the cecum (beginning of the ascending colon) back into the small intestine. Sometimes in this way, several feet of the small intestine may be filled with fecal material forced back from the colon. Says Schmidt as quoted by Kellogg: “The ileo-cecal valve forms a sharp line of demarcation above which (that is, in the small intestine) putrefaction never occurs except under conditions of disease. If protein decomposition extends up into the small intestine far greater quantities of indican (indicative of putrefaction) appear in the urine than ever occur through absorption in the colon.” Patients in whom the valve is wholly incompetent, continues Kellogg, are usually subject to a most distressing accumulation of gas in the intestine. The crippled valve may be repaired by a surgical operation that has been done in many cases with marked benefit to the patient. But the operation is not likely to be a permanent success for the reason that it, deals only with a result, the cause of the trouble, the over-distension of the colon, still remaining. The rigid anti-toxic diet is of the highest importance in cases of this sort. The food should be of such a character that the residues will not encourage putrefaction even if delayed for some time in the colon, and the intestinal flora should be changed (discussed elsewhere). If the bowels cannot be made to move freely they should be emptied by means of an enema at night. The best temperature is from 80° to 90°.