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—In the diagnosis of internal strangulation, no matter from what cause, we have exactly the same symptoms as in strangulated hernia, except the physical signs are different. The symptoms of internal strangulation are as follows: Pain in the abdomen which comes on suddenly, gradually increasing in intensity for the first half hour, followed by nausea and vomiting, and inability to produce bowel movement. If the strangulation be severe, there is an increase in the frequency of the pulse (but as a rule in the early stage the pulse is not accelerated), absence of temperature, absence of tenderness. As the case advances, if the strangulated coil be large, it can be recognized through a moderately thin abdominal wall by its distension; the coil of the intestine leading to it may also be recognized by a circumscribed elevation of the abdominal wall. In twenty-four hours all of these symptoms will
MURPHY JB. ILEUS. JAMA. 1896;XXVI(2):72–76. doi:10.1001/jama.1896.02430540024002i
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