Bauhinospasm

BAUHINOSPASM. Spasm, as well as insufficiency of the Bauhin valve, have attracted the attention of surgeons in recent years, thanks to the accumulated large body of observations on the long-term results of appendectomies performed for chronic appendicitis. The ineffectiveness of operations to remove the vermiform appendix in a number of cases has found its explanation in Bauhinospasm. Surgical intervention during repeat operations for these so-called "pseudo-appendicitis" cases, when the surgeon corrected disorders of the Bauhin valve by one operative method or another, resulted in a positive outcome in terms of the patient's recovery. This provides grounds to distinguish Bauhinospasm as a separate nosological entity. Anatomical studies show that the Bauhin valve is not only a partition separating the small intestine from the large intestine, the doors of which open toward the large intestine, but that it is a complexly constructed shutter (see Bauhin valve), in which a circular muscle—the Keith-Elliot sphincter—is distinguished; spastic contractions of this sphincter produce a number of symptoms that are clinically difficult to differentiate from the attacks characteristic of chronic appendicitis. Some authors emphasize the dependence of pylorospasm on spasms of the Bauhin shutter. During operations undertaken for chronic appendicitis, especially in those cases where the anamnesis does not note a more or less typical attack of acute appendicitis, it is recommended to make an incision wide enough to freely examine the area where the small intestine enters the cecum. If there is a spasm of the shutter, then a finger inserted through the cecum to the Bauhin valve finds the sphincter so strongly contracted that it cannot overcome this contraction without force; even the tip of the little finger is tightly gripped, like a ring, by the contracted sphincter. This does not occur with a normal shutter, nor, even more so, with insufficiency of the Bauhin valve. The distal end of the ileum is found to be hypertrophied for a length of several centimeters, which must be considered as compensatory hypertrophy of the muscle layers of the intestine as a result of the struggle against the contracted sphincter.—Therapy. If long-term treatment aimed at spastic contractions of the intestine (general strengthening treatment, rest, heat, preparations of atropine and belladonna) does not yield definitely positive results, then during the undertaken surgical intervention, one must not limit oneself only to the removal of the vermiform appendix, but it is necessary to also dissect the sphincter of the Bauhin shutter; the sphincter is dissected over a finger inserted through the wall of the cecum into the Bauhin valve; the mucosa may not even be opened; the wound on the intestine is closed according to the type of Heineke-Mikulicz pyloroplasty. The operation is called 'bauhinoplasty'.