Symptomatology

It is well known that enteroptosis may exist without giving rise to any symptoms whatever. In most instances, however, various morbid manifestations are encountered. The latter are not always due to enteroptosis alone, but rather to coexisting disorders of the digestive tract. The following are the symptoms which must be assigned to the enteroptosis alone: The patient often complains of some faintness or a certain weakness after rising. There is frequently a feeling of considerable fatigue after slight exertion, principally after walking. In women this is also combined with pronounced backache. A feeling of weight is occasionally experienced in the lower half of the abdomen, while a dragging sensation is felt in the epigastric region. Flatulence is often encountered; constipation is present in most of the cases, and frequent micturition in a considerable number. Aside from these direct symptoms, it is safe to say that any disease of the digestive tract, complicating enteroptosis, does not show the same tendency to yield to the usual remedies as normally. The abnormal position of the abdominal viscera produces a weakening effect upon the resisting power of the organism and its energy in combating maladies, especially when the latter exist in them.

This explains why the greater part of patients with enteroptosis are troubled with one or the other variety of stomach or bowel disorder, or both. Cases of enteroptosis, lasting a long period, frequently lead to pronounced anaemia, in consequence of subnutrition. The latter gives rise to a host of nervous manifestations (neurasthenia).

As a good instance of the subjective symptoms of enteroptosis, I describe the following case:

December 2d, 1900. - Moses C------, 30 years old, has been suffering for a long time from constipation. He has had this since childhood, as far back as he can remember. He has never vomited, but suffers from distress in the stomach This organ feels as though suspended and filled with a heavy weight. Often it feels as if it were bobbing up and down, quivering once or twice. He declares that he is conscious of having a stomach. He can eat everything, but sometimes even a glassful of water will produce a feeling of distress. He sleeps well, but has no appetite, and is troubled a good deal with flatulence. On rising he feels had. having sometimes nausea.

Present Condition

A very nervous, slim young man. The heart and lungs are normal. The stomach reaches two tinkers below the navel: the liver is somewhat descended, about one finger below the right costal margin. The right kidney, on deep inspiration, can be palpated in its lower third. Chemical examination of stomach contents one hour after the test breakfast shows the presence of free HC1 and a total acidity of 80. Weight, one hundred and thirteen pounds.

Objective Symptoms

Patients with enteroptosis are. as a rule, thin and slender, and often appear younger than they really are. The abdominal walls are generally flaccid, and the abdominal cavity appears to be too commodious for its contents. Palpation is extremely easily executed in these patients, there being, as a rule, no rigidity of the muscles. When the patient stands, the lower part of the abdomen shows a round protrusion, which begins at the navel, while the epigastric region presents a caved-in appearance. This is principally found in female patients. In the latter, a pendulous abdomen may be encountered, especially in those who have had children. In the same class of patients diastases of the recti muscles are occasionally met with.

The stomach occupies a low position - gastroptosi.i - that means the greater as well as the lesser curvature has been pushed downward. The abnormal position of the stomach can be easily demonstrated by the following three procedures:

1. Splashing sound. 2. Inflation of the stomach with gas. 3. Gastrodiaphany. The most convenient and easiest means is the splashing sound. On tapping, principally upon the left side of the abdomen below the margin of the ribs, in a partly filled condition of the stomach, there will be no sound audible immediately below the ribs, while somewhat farther down in the region of the navel, above and below it, the splashing can be distinctly heard. The area over which this splash can be produced will indicate the position of the stomach. Inflation of the stomach with gas, as well as gastrodiaphany, will certainly distinctly show the descent of the stomach; but these procedures, being a little more complicated, should be reserved for doubtful cases.

Strong pulsation of the abdominal aorta is frequently encountered, and is probably due to the partial uncovering of this vessel by the slipping down of the stomach. The transverse colon, the caecum, and part of the ascending colon, as well as the sigmoid flexure, can often be distinctly palpated. The transverse colon is frequently found in these cases as a ribbon-like body running horizontally above the navel. This Glenard designated as "corde colique transverse," and concluded from the size of the cord, which is considerably smaller than we should expect the colon to be, that there is a condition of enterostenosis, or a narrowing of the bowel. Ewald and others are of the opinion that the ribbon-like body felt does not represent the colon, but the pancreas. My own view, however, coincides with that of Glenard. For in some instances the corde colique is found in the region of the navel, or even somewhat below it - where the pancreas never exists - and again occasionally in palpating this transverse band a gurgling sound is heard.

Furthermore, it can sometimes be traced to the ascending colon.

Movable kidney is another essential symptom of enteroptosis. The recognition of the movable kidney is quite easy. It is only necessary to practise palpation with both hands, putting one hand on the back of patient behind the lumbar region, while the other hand is held flat below the margin of the false ribs covering the lower outside angle of the abdomen. By having the patient inspire deeply, the kidney, if movable, is felt to slip between both hands; slight pressure with the hand on the lumbar region will facilitate the recognition of an existing movable kidney.