Definition

Downward displacement of the stomach, right kidney, and other organs of the abdominal cavity, attended with digestive disturbances.

General Remarks

Descent of the stomach as well as of other abdominal organs was described many years ago by Virchow, Leube, Landau, and other authors; yet to Glenard 1 must be awarded the credit of having first sufficiently emphasized the importance of this condition, of having recognized its clinical significance, and established it as a distinct affection.

The idea which led the French physician to the discovery of the disease designated by his name was the fact that the whole digestive tract, which from the mouth to the anus is ten or fifteen times longer than a straight line connecting both points, is arranged in lF. Glenard: Lvon Med., 1885, p. 450, the form of different baldachins suspended on six loops1 by means of ligaments at the posterior wall of the abdomen.

The zigzag direction of the loops offers the possibility of too great a bend, sometimes at such an acute angle that it causes obstruction to the passage of the ingesta or secretions at the six main points of fixation. This might occur at the gastro-duodenal, duodeno-jejunal, or transverse,2 sigmoido-rectal curvatures.

The ligaments are not all of equal strength and the points of fixation of several of them are especially weak. This is true of the gastro-duodenal and the transverse colon ligaments. Thus, from a theoretical point of view, it is apparent that the possibility exists that the weak ligaments may give way under favorable conditions, and that a falling of that part of the intestine may result. This would naturally exert increased traction on the next fixation point, and might cause an obstruction to the passage of the contents of the intestine, or, in other words, a partial entero-stenosis. In forty autopsies Glenard several times found the colon transversum displaced and stenosed. He recognized that these changes in the anatomical position must give rise to troubles, which should be considered dependent upon this condition. In examining all his patients with digestive troubles, he found that there were many so-called "nervous dyspeptics" in whom he could discover, by a thorough investigation of the abdomen, that some abnormal position of the intestines existed.

1 (1) Anse gastrique; (2) arise duodenale; (3) anse ileo-colique; (4) anse colique transverse; (4 a) costo sous-pylorique; (5) sous pyloro-costale; (6) anse colo-sigmoidale.

2 "Colique sous-costal droit," "colique sous-costal gauche," "sous-pylorique du transverse".

Etiology

It is generally accepted that the corset plays a predominant part in the causation of the downward displacement of the abdominal organs; confinement is also believed to be a great factor of this disorder. But besides these two points, which refer only to the female sex, there are some other conditions which likewise predispose to enteroptosis and have reference to both sexes, namely, acute diseases of a grave nature and protracted ailments accompanied by a considerable loss of flesh.

Stiller1 assumes that enteroptosis represents a congenital anomaly, since he also found in these cases a floating tenth rib. As is well known, normally only the eleventh and twelfth ribs are floating, while the tenth rib is fixed by means of its cartilage to the thorax. This anomaly Stiller designated as the "costal stigma." His assertions, however, that the costal stigma represents a positive sign of enteroptosis have not been substantiated.

Although in many instances the weakness of the abdominal walls takes its origin in a congenital disposition to this anomaly, there is no doubt that cases are met with in which a congenital factor certainly does not come into play. To the latter category belong those instances of enteroptosis which develop after rather sudden great losses of flesh, no matter what be their cause, and also after abrupt changes in the volume of the abdominal cavity.

Enteroptosis is found quite frequently, especially among women. In order to give a clear illustration of this fact, I take at random the number of patients recorded in my private day book for the months of January and April, 1896. In the month of January I saw 57 male patients with gastric disturbances; among them were 4 with a distinct enteroptosis and right movable kidney (third and fourth degrees); the number of women with the same disturbances amounted to 33, and 13 had distinct enteroptosis with right movable kidney. The month of April showed similar figures: Number of male patients, 84; enteroptosis with movable kidney, 5. Number of females, 59; enteroptosis with movable kidney, 19. The figures of these two months put together show: Number of male patients, 141; enteroptosis with movable kidney, 1*. Number of female patients, 92; enteroptosis with movable kidney, 32. We find the percentage of enteroptosis to be 6.2 among the male patients with digestive disorders, while in the females similarly afflicted we find the percentage to be 34.8. The great frequency of enteroptosis which has been noted by Gle-nard is fully sustained by the figures just given.

1Stiller: Arch. f. Verdauungskrankh., 1896, vol. ii., p. 285.

Inasmuch as statistical material gains in value the greater the number from which the deductions are made, I1 took the trouble to examine all my private patients of the year .1900, with regard to the occurrence of visceral ptoses. The greater contingent of my eases consisted of patients with digestive disorders. The total number amounted to 1,912 patients - l,080 males, 832 females. Among these there were en-countered 347 cases with ptoses of the abdominal viscera, 70 among the men and 277 among the women. Among these there were 240 cases of enteroptosis, 20 in men and 220 in women.

1Max Einhorn: "Remarks on Entoroptosis." Medical Record, April 13th, 1901.

In most of the cases the enteroptosis was accompanied by a movable kidney, namely, 212 - 18 in men and 194 in women. The assertion of Trastour, "Movable kidney is the habitual satellite of enteroptosis." appears thus to be correct. Among the cases of enteroptosis with movable kidney, 23 had also a descent of the liver - 3 men and 20 women. Enteroptosis with floating liver, unaccompanied by movable kidney, was noted in 12 cases - 1 in a man and 11 in women. Enteroptosis alone (the kidneys and liver being in their normal places, the only symptoms being a descent of the stomach and a strong pulsation of the abdominal aorta) was found in 15 cases - 1 male and 14 female. Movable kidney alone, not accompanied by general enteroptosis, was encountered 57 times - 21 in males and 36 in females. Floating liver alone was found in 39 cases - 25 male and 14 female.