Primary carcinoma of the duodenum / by W. Soltau Fenwick.

  • Fenwick, W. Soltau (William Soltau)
Date:
1910?]
Catalogue details

Licence: Public Domain Mark

Credit: Primary carcinoma of the duodenum / by W. Soltau Fenwick. Source: Wellcome Collection.

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    firm consistence, which extended to within 2 in. of the iliac crest, and yielded a resonant note on percussion, being apparently overlapped by^ the distended colon. Swelling not tender. Patient very drowsy and thirsty. Temperature, 103° *2. February 19.—Jaundice increased; swelling larger; liver dnlness reached iliac crest; no pain, but tenderness on palpation over the liver. February 20.—The localised swelling has increased in size, and fluctuation could be detected. Slight oedema of the abdominal wall; patient weak and torpid, with hectic flush on cheeks; pulse, 100; temperature, 102°*7. February 21.—Patient suddenly became worse ; acute pain in the abdomen, which was distended and tympanitic. Died the following day. Necropsy.—The peritoneal cavity contained several pints of sero- hilious fluid and about a quarter of a pint of pus, which escaped from a perforation in the gall bladder. The intestines were coated with recent lymph and the coils glued together. The gall bladder was enormously dilated, and measured, when empty, 8 in. in length and 4^ in width. On its under surface was an opening the size of a sixpence, with thickened and ragged edges. The common bile, cystic, and hepatic ducts were all dilated. On opening the duodenum a soft growth was found, entirely surrounding the orifice of the bile duct and invading the intestine for 3 in. in its long axis, and involving half its circumference. Above the growth the bowel was much dilated. The lymphatic glands in the neighbourhood were enlarged, but there were no metastases in the liver. On section the growth proved to be a spheroidal cell cancer. When carcinoma attacks the wall of the duodenum, and only invades the biliary papilla during the course of its growth, the clinical picture it presents is somewhat different to the preceding. Should the disease have commenced high up, the initial symptoms are those of pyloric obstruction. Pain or discomfort is experienced two or three hours after food, and there are usually flatulence, acidity, and vomiting, with signs of hypertrophy and dilatation of the stomach. The vomit is usually devoid of free hydrochloric acid, but occasionally it presents a green colour owing to regurgi¬ tation of bile through the partially obstructed bowel. HEcma- temesis and melsena may occur from ulceration of the growth, and may even prove fatal. Should the disease undergo colloid de¬ generation, small semi-transparent granules of colloid material sometimes appear in the faces. When the growth develops below the level of the papilla, the first symptoms are those of obstruction of the bowel, with constant vomiting of bilious fluid containing trypsin. In either case its extension is to the orifice of the bile duct, is followed by jaundice, with enlargement of the liver and gall bladder. It should be noticed, however, that even when this complication ensues, a certain amount of bile may still appear in the vomit or faces, while in some cases the only indication of biliary obstruction consists in the continued presence of bile in the urine, and dis¬ tension of the gall bladder.
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