The frequent necessity of resection for the relief of intestinal obstruction is a somber commentary on the diagnostic ability of the profession. In the very large majority of cases, delay in surgical interference is responsible rather than the primary cause of the ileus. The favorable cases are those in which there is interruption to the fecal current without vascular strangulation. The need for resection, however, usually arises from the damage to the blood supply rather than from blocking of the intestinal lumen.
The important considerations are, first, the extent of vascular involvement; second, the degree of infection; third, amount and toxicity of the obstructed intestinal contents. The upper intestinal tract is comparatively free from pathogenic bacteria. Their number and virulence gradually increase toward the ileocecal orifice, and as demonstrated by Herter, the terminal two feet of the ileum teem with these organisms. The walls of the empty intestine are comparatively