President Eisenhower and his bowel obstruction

The 34th president of the U.S., Dwight D. Eisenhower, underwent surgery on June 9, 1956, to treat a small bowel obstruction. After a distinguished career in military and public service, Mr. Eisenhower assumed the presidency in 1952 at age 62.¹ A debilitating myocardial infarction in 1955 had already complicated his tenure when he began experiencing severe abdominal pain on June 8, 1956, after a dinner soirée featuring Jane Powell and Bob Hope.

President Eisenhower had suffered bouts of intestinal discomfort throughout his life, with severe symptoms in 1923 resulting in an uncomplicated appendectomy. After another episode in May 1956, his physicians diagnosed him with Crohn’s disease, a pathology only recently described in the medical literature.^2,3 As President Eisenhower’s condition degenerated, bowel obstruction from postoperative adhesions versus Crohn’s disease were the diagnoses debated among his physicians.

This abdominal pain began just after midnight on June 8. The president’s personal physician, Howard Snyder, MD, initially assumed this episode would pass like the others and prescribed Milk of Magnesia and a tap water enema. The pain worsened, complicated by bilious vomiting. As President Eisenhower’s heart rate climbed and his blood pressure dropped, Dr. Snyder initiated intravenous hydration, consulted surgery, and transferred the president to Walter Reed Army Hospital, Washington, DC, where his vital signs stabilized. Once the president was admitted to the hospital, a nasogastric tube was placed that promptly drained voluminous gastric fluid, and radiographs confirmed the clinical diagnosis of bowel obstruction.

The surgical team assembles

The surgical team consisted of Leonard Heaton, MD, FACS, Surgeon General of the U.S. Army; Isidor Ravdin, MD, FACS, chairman of surgery, University of Pennsylvania, Philadelphia; Brian Blades, MD, FACS, chairman of surgery, George Washington University, Washington, DC; and John Lyons, MD, FACS, the premier private practice surgeon in Washington at the time. When the president’s condition failed to improve and follow-up radiographs evidenced worsening obstruction, the surgical team unanimously agreed to operate. President Eisenhower’s cardiologists concurred that he could tolerate a laparotomy, albeit at higher risk. With Dr. Heaton designated as primary surgeon and Dr. Ravdin as first assistant, the operation commenced.⁴

In the early morning hours of June 9, the team explored President Eisenhower’s abdomen through a right paramedian incision. After lysing adhesions, they found 30–40 cms of thickened, indurated, contracted terminal ileum resulting from Crohn’s, the source of the obstruction. They did not observe any active inflammatory bowel disease and elected to bypass the obstruction with an ileocolostomy rather than resect the diseased bowel. Intestinal bypass was a common operation in the 1950s, but the choice nonetheless precipitated much controversy from physicians who believed it left the president at increased risk for recurrence. Subsequent events proved the team’s decision correct.⁵

President Eisenhower’s recovery was essentially unremarkable except for a minor wound infection. His prolonged convalescence in the hospital and at his Gettysburg, PA, farm did complicate foreign relations and arguably contributed to the 1956 Suez crisis among Egypt, Israel, Great Britain, and France. President Eisenhower’s incapacity following the operation and his heart attacks eventually led to the 25th Amendment, which established contingency plans for presidential disability and was ratified in 1967.⁶ His health continued to deteriorate, with a major stroke in his second term and multiple myocardial infarctions and bowel obstructions through the 1960s. A severe obstruction in February 1969 required a subsequent operation for adhesive disease. President Eisenhower died on March 28 following this surgery from yet another myocardial infarction.⁷

The American College of Surgeons (ACS) provided a supporting role throughout President Eisenhower’s treatment for his small bowel obstruction. In fact, Dr. Ravdin was presiding over an ACS Board of Regents meeting in Chicago, IL, when his wartime friend Dr. Heaton summoned him to the nation’s capital. Dr. Ravdin decamped mid-meeting, leaving Loyal Davis, MD, FACS, the 43rd President of the College, in charge. The day after President Eisenhower’s operation, the Board of Regents sent Dr. Ravdin a formal letter of reprimand for practicing itinerant surgery.⁸ In this same, contradictory missive, the Regents simultaneously complimented Dr. Ravdin on “the honor he brought” to the College; it has been this panegyric narrative that has endured. In 1960, Dr. Ravdin served as President of the ACS.

President Eisenhower formally acknowledged the College for its leader’s assistance, and the College inducted him as an Honorary Fellow in 1957.^9,10

---

References

1. Ambrose S. Eisenhower. New York, NY: Simon and Schuster; 1983.
2. Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis: A pathological and clinical entity. Am J Med. 1952;13(5):583-590.
3. Mulder DJ, Nobel AJ, Justinich CJ, Duffin JM. A tale of two diseases: The history of inflammatory bowel disease. J Crohns Colitis. 2014;8(5):341-348.
4. Heaton LD, Ravdin IS, Blades B, Whelan TJ. President Eisenhower’s operation for regional enteritis: A footnote to history. Ann Surg. 1964;159:661-666.
5. Pappas TN. President Eisenhower’s bowel obstruction: The story of his surgeons and their decision to operate. Ann Surg. 2013;258(1):192-197.
6. Gilbert RE. The impact of presidential illness on the administration of Dwight D. Eisenhower. Politics Life Sci. 2012;31(1-2):16-35.
7. Hughes CW, Baugh JH, Mologne LA, Heaton LD. A review of the late General Eisenhower’s operations: Epilogue to a footnote to history. Ann Surg. 1971;173(5):793-799.
8. Ravdin IS. Letter to the American College of Surgeons Board of Regents. June 10, 1956. University of Pennsylvania Archives and Records Center. I.S. (Isidor Schwaner) Ravdin Papers 1912–1972. Box 14, Folder 7.
9. Ravdin IS. Telegram to the American College of Surgeons from President Eisenhower. October 5, 1956. University of Pennsylvania Archives and Records Center. I.S. (Isidor Schwaner) Ravdin Papers 1912–1972. Box 12, Folder 6.
10. Six distinguished men receive honorary fellowships. Bull Am Coll Surg. 1958;43(1):16-17. Available at: facs.org/about-acs/archives/acshistory/honoraryfellows. Accessed August 1, 2017.