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Intraulminal recordings of motility were made from a patient with chronic idiopathic intestinal pseudoodstruction. Contractile activity was recorded from esophagus and duodenum with and without cholinergic stimulation. Electrical activity was recorded from duodenum with and without cholinergic stimulation. Contractile and electrical activities were recorded from the sigmoid colon at rest and after morphine. Gastric fundic relaxation was measured during balloon distention. This patient showed abnormalities of esophageal function similar to achalasia, while gastric fundic relation was impared, with a more rapid rise in pressure on distention than is seen in normal persons. Duodenal and colonic electric control and response activities were present on occasion. Duodenal contractions occurred in response to both bethanechol and edrophonium. Therefore, the efferent cholinergic system of the small bowel appears to be functional in this case of idiopathic intestinal pseudoobstruction. The nonardrenergic inhibitory control of esophagus and gastric fundus appears to be functioning abnormally.

Etiologic and physiopathologic aspects of volvulus of the sigmoid colon in Brazil are presented. It is believed that sigmoidal volvulus in Brazil is a frequent complication of megacolon caused by Chagas' disease, differing in some characteristics from volvulus found in other countries. A review of 230 cases treated between 1938 and 1974 in the Surgical Department of Hospital das Clinicas, University of Sao Paulo School of Medicine, is presented. The successive variations used to treat this disease occurred parallel to those introduced in the surgical treatment of uncomplicated megacolon. From the results, the following treatment is recommended: endoscopic emptying in cases without clinical, roentgenographic or endoscopic signs of intestinal ischemia. Laparotomy should be performed when a complicated volvulus is suspected or when it is not possible to empty the loop. When a simple volvulus is found, the loop should be untwisted and the gaseous contents siphoned off by menas of a rectal catheter. When there is necrosis of the colon, the Hartmann operation is recommended. It is important to submit patients to a definitive treatment of the megacolon soon after endoscopic emptying or surgical detorsion of the volvulus, since recurrences following these measures are frequent.

The duration of postoperative ileus and changes in contractile frequency of circular muscle were recorded in the colon of monkeys before and after primary resection for distal large bowel obstruction. Obstruction was induced gradually by an implanted device. Resection and primary anastomosis resulted in reduced contractile frequency (postoperative ileus) lasting less than 48 h, significantly shorter than the period of ileus after a control laparotomy.

Strain gauges and electrodes to detect intestinal motility were attached to the terminal ileum, right and left sides of the colon in Rhesus monkeys. Baseline recordings were made. An obstruction device was applied to the left colon at a laparotomy. Compromise of the bowel lumen leading to total obstruction occurred at 13 +/- 2 days. As obstruction progressed, contractions decreased in the terminal ileum and right colon but increased in the left colon proximal to the obstruction. Distention wave forms increased in the colon proximal to the obstruction. Visible intestinal movement, borborygmi and signs suggesting colic were accompanied by a motility phenomenon, simultaneous mass actions, not seen in normal unobstructed bowel. The obstructed segment was resected and an anastomosis made. The motility recordings revealed that postoperative ileus persisted for less than 48 hours and motility returned to normal significantly earlier than after a control laparotomy.

The results of treatment for volvulus of the colon during 13 years in a community hospital are analysed, It is concluded that sigmoid volvulus should be treated with proctoscopic examination and insertion of a rectal tube, unless signs of gangreana or peritonitis are present. In patients without accompanying sever diseases, elective resection should be performed later. Repeated tube decompressions should be attempted in patients with recurrence and high operative risk. Unsuccessful tube decompressions or signs of a non-viable colon should be followed by emergence laparotomy and, probably, resection of the sigmoid colon whether gangraena is present or not. Volvulus of the cecum should be treated with operative reduction and pexia or cecostomy, unless gangreana necessitating a hemicolectomy is present.

Postoperative electromechanical activity of the gastric antrum, small bowel, right colon, and sigmoid colon was recorded in stumptail monkeys in response to retroperitoneal dissection and transient clamping of the renal pedicle. Bipolar silver electrodes and extraluminal bonded strain gauge transducers were used to record slow-wave and spike discharges and contractions of intestinal smooth muscle. After operation myoelectric activity was decreased transiently in the antrum and for only a few hours in the small bowel. Right colon contractile activity was decreased significantly for 24 hours and that of the sigmoid colon for 72 hours. Postoperative inhibition of bowel motility appears to be most profound and persistent in the colon.

The incidence of intestinal volvulus gleaned from the world's medical literature spread over the past seven decades supports the contention that this bowel disorder has distinct geographical predilections. Sigmoid volvulus, invariably superimposed upon a redundancy of this part of the bowel, probably results from a functional disturbance of the colon mediated perhaps by a high-residue vegetable diet. The same factors appear to hold for small bowel volvulus, though caecal volvulus occurs strictly on the basis of preexisting anatomical abnormalities.