Secondary Membranous Colitis is the term given to a condition in which there is a membranous deposit upon the walls of the colon secondary to some other disease. The disease is not a local condition and sometimes presents no symptoms referable to the sigmoid or rectum. In a few cases rectal symptoms develop and there will be a discharge of blood, pus and mucus.

Causes: The condition arises from a traumatize to the colon or from swallowing some corrosive substance, particularly mercury. Mercury in toxic doses is supposed to be absorbed in the stomach and re secreted in the colon, producing an excessive quantity of mucus or the so-called membrane, as the result of irritation or inflammation. Patients suffering from acute septicemia, or from uremia in which the whole body is involved in the toxic process, with great debility, lowered circulation and vital depression are subject to this disease.

The original or primary disease of the kidney, lungs or heart may present the most marked symptoms with those of a secondary membranous colitis existing only as a complication.

When due to septicemia this disease is probably to be regarded only as a complication of septic infection. Diabetes is sometimes associated with this disease. Treatment is directed to the primary disease.

Follicular Colitis. The solitary follicles are found in the rectum, sigmoid and colon. These inflamed follicles are present much more frequently in the mucous membrane of the colon proper, with the abscess dipping down into the sub mucous tissue. They become inflamed as the result of a chronic hypertrophy catarrh colitis which causes such a pressure upon the glands that there is a necrosis with the formation of a small well defined circular ulceration. These ulcers may be very large in number and scattered throughout the mucous membrane. It is said by some authors that a follicular colitis is found more commonly in children than adults.

Causes. It occurs as the result of some other inflammatory disease or during its course. It may be associated with a tubercular or chronic ulceration of the bowel.

Symptoms. When the disease presents itself in the digmood and colon the symptoms are much the same as of a chronic hypertrophy catarrh inflammation. When the ulceration is situated in the rectum or sigmoid the stools contain mucus and pus: there is a frequent desire to defecate and a marked tenderness over the sigmoid and the lower end of the spine. These patients suffer from a marked digestive disturbance, and present the symptoms of a hypertrophy catarrh inflammation, having diarrhea alternating with constipation. When the disease is in the rectum the finger may feel the slight elevations giving the impression of military tuberculosis.

The Diagnosis is made with the proctorial or kaleidoscope and is dependent almost exclusively upon the visual aspect.

Treatment. Treatment depends upon the constitutional condition and the local condition in the form of obstruction or pressure. The condition may be due to a severe form of hypertrophy catarrh inflammation which will have to be treated when low down in the intestine, through a kaleidoscope or when high up in the intestine by means of irrigation from above. When the intestinal contents seem to cause irritation, the bowel should be cleaned out every second day or once a week, by the administration of Epsom salts. This not only removes the irritating material, but also tends to deplete the congested mucous membrane. Castor oil given in small doses each day is of much value in controlling some cases where diarrhea is a pronounced symptom. In cases where the disease is located in the upper colon and it is impossible to use efficiently the rectal irrigation of Kramer or witch-hazel, a colostomy or appendicitis should he performed.

Valvular Colostomy This operation described as Gibbon’s valvular colostomy is applicable to the treatment of all the forms of chronic colitis. Appendicitis appears more attractive to the greater number of surgeons for the reason that it seems easier to perform, yet it has a few disadvantages. Appendicitis has the objection that the lumen of the Appendix is sometimes obliterated and that the tension necessary in some cases is so great in pulling the appendix out through the abdomen that sloughing of the entire appendix occurs as the result of interference with the circulation. This sometimes happens even when the appendicitis artery has not been ligated.

A colostomy offers the favorable conditions that the cecum lies directly in contact at the site where the opening is to be made and that the leakage from the opening can be controlled equally as well as in appendicitis

Gibbon’s Valvular Colostomy is performed as follows: An opening about one and a half inches long, parallel to and just above Forepart’s ligament is made through the abdomen. The fibers of the muscular layers are split after the gridiron method and the peritoneal cavity entered. An opening large enough to admit a large-sized soft rubber catheter is then made in the anterior longitudinal band of the cecum. Into the serous surface of the gut two or three tiers of sutures are then introduced so as to form a valve or infolding of the gut into the lumen of the intestine. The last tier of sutures are left long and brought through the edges of the wound, in that manner fastening the gut in apposition with the abdominal parietal The soft rubber catheter is allowed to remain in the wound for ten or more days until the parts have healed. After this the catheter may be reintroduced and taken out as often as necessary for the purpose of irrigating. The fecal fistula, which is very small, can be controlled by a small gauze pad and the patient permitted to go about his work.