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Updated: July 21, 2025
The general resistance is lowered from nerve-exhausting habits; the general tone of digestion is below par and the bowel contents are maintaining a higher toxic state than usual; we have added to this condition an unusual tax in a long run of hot weather, business worries or unusual mental, physical or digestive strain, following which acute intestinal indigestion manifests with a sudden explosion; or there takes place a transformation of the contents of the bowels into an intense putrefaction which infects a portion of the mucosa that has been rendered susceptible by pressure from fecal impaction, concretions, or any cause capable of devitalizing.
After the recovery of his body it was seen that his false teeth were impacted at the anterior opening of the glottis, and it was presumed that the shock caused by the plunge into the cold water had induced a violent and deep inspiration which carried the teeth to the place of impaction.
Treatment. The general treatment of embolic gangrene is the same as that for the senile form. Success has followed opening the artery and removing the embolus. The artery is exposed at the seat of impaction and, having been clamped above and below, a longitudinal opening is made and the clot carefully extracted with the aid of forceps; it is sometimes unexpectedly long (one recorded from the femoral artery measured nearly 34
The extent of the gangrene depends upon the site of impaction of the embolus, thus if the abdominal aorta becomes suddenly occluded by an embolus at its bifurcation, the obstruction of the iliacs and femorals induces symmetrical gangrene of both extremities as high as the inguinal ligaments.
There is sudden pain at the site of impaction of the embolus, and the pulses beyond are lost. The limb becomes cold, numb, insensitive, and powerless. It is often pale at first hence the term "white gangrene" sometimes applicable to the early appearances, which closely resemble those presented by the limb of a corpse.
Portions of malignant tumours also may form emboli, and their impaction in the vessels may lead to the development of secondary growths in distant parts of the body. Fat and air embolism have already been referred to. Pyogenic. Non-suppurative inflammation of the coats of an artery may so soften the wall of the vessel as to lead to aneurysmal dilatation.
Clinically, loose bodies composed of fibrin constitute an unimportant addition to the features of the disease with which they are associated. They never give rise to the classical symptoms associated with impaction of a loose body between the articular surfaces.
When an embolus becomes impacted at the bifurcation of the popliteal, if gangrene ensues it usually spreads well up the leg. When the axillary artery is the seat of embolic impaction, and gangrene ensues, the process usually reaches the middle of the upper arm.
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