Enteroptosis.
Synonyms:—Glenard's disease; viceroptosis.
Definition:—Enteroptosis is a condition in which the abdominal contents are displaced to a lower level than they normally occupy because of stretching of their supporting ligaments and laxity of the abdominal wall. The condition may affect one or more of the abdominal viscera.
Etiology:—There are two groups of cases. First, those seen in women who have had repeated pregnancies and who are thin, or who have lost flesh markedly. Frequently the condition in these persons gives rise to no symptoms.
The second group of cases is seen in young persons who are thin, and especially those who are wasted from acute disease. Many more women are affected than men. Such patients constitute a neurotic group, being the subjects of neurasthenia or hysteria. The wearing of constricting bands and corsets furthers the process in such patients. Cases are seen among the insane when conditions of wasting, chronic constipation and inactivity coexist. Occasionally the aged are the subjects of this disorder.
Symptomatology:—The most constant train of symptoms are of a dyspeptic nature. The patient complains rarely of abdominal pain, but usually of abdominal discomfort. There is a more or less constant sense of the possession of abdominal organs. Frequently there is the sensation of motion in the abdomen; rumblings and noises are common. There may be a feeling of chronic weariness, with dull aching, especially in the back. Sometimes the appetite is diminished; at others the patient desires food with the feeling that the discomfort will be relieved. Palpitation and shortness of breath are not uncommon. Constipation is usual, but, often, after the taking of cathartics with apparent good results, there is no sign of relief. On examination the patient appears thin and wasted. The epigastrium appears empty, while there is unusual fulness just below in the bowels. Inflation of the stomach may reveal the lower curvature a hand's breadth below the umbilicus, and possibly the whole organ will occupy a position in which the long axis is parallel with the long axis of the body. Peristaltic waves may be frequently seen in the stomach and intestines. Throbbing of the abdominal aorta is a usual visible accompaniment.
Upon palpation the transverse colon may appear as a cord-like structure, curved or bent downward. One or both kidneys may be prolapsed, more frequently the right one.
Percussion may reveal the liver and spleen displaced downward to a variable extent. In extreme cases these organs may occupy the lowermost zone of the abdomen.
Diagnosis:—The above named symptoms, with the findings, constitute the diagnosis of enteroptosis. Stress is particularly laid on the finding of the ptoses, as the other symptoms are those of an independent neurasthenia or dyspepsia.
Treatment:—Drugs alone in the treatment of this condition will produce no permanently satisfactory results. Bandages or other supports must be applied, which, after careful replacement, will retain the contents of the abdominal cavity in as near normal position as possible. These patients always observe that any support to the abdomen affords considerable relief. After the replacement, massage, electricity or vibration will exercise a local influence upon the muscular and nervous structure of the intestines which will go far toward the restoration of normal tone.
With the benefits derived from the above measures, the use of hydrastis, xanthoxylum, capsicum and nux vomica, singly or in proper combination, will do as much towards restoration of the function of the organs, as any remedies we could name. It is seldom necessary to give capsicum and xanthoxylum at the same time. The former has an effect upon the nervous and muscular structure of the intestinal tract alone, and upon the capillary circulation of these organs, while the latter with hydrastis influences the central nervous system in conjunction with their influence upon the intestinal tract.
Constipation, in this condition, must be treated with much care, and active irritating cathartics must be persistently avoided, as they impair the tone of the intestines. In prescribing a diet for these patients, fruits, easily digested foods and non-fermenting articles of diet must be selected. Concentrated foods, such as cheese and butter, with the heavier articles of starchy foods, such as beans, peas and corn, should be avoided. The patient should take a small meal only at a time, even if it is necessary to take this four or five times each day. Furthermore, it is necessary to observe the digestive powers of the stomach, and assist in every way possible the digestion of the food. If an acid is indicated, give hydrochloric acid; if there be an excess of acids, give some neutralizing remedy that exercises a tonic influence. The syrup of rhubarb and potassium compound, to which capsicum and hydrastis are added, may be given with regularity as long as the acidity remains. Among the digestives the essence of pepsin may be used when acids are deficient, as it usually contains a mild acid. Pancreatin or paw-paw will be of much service in selected cases.
