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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    of a few grains of bicarbonate of sodium, tlie filtrate digested fibrin. The urine was much reduced in amount, and contained a trace of albumin. After the stomach had been washed out overnight, and no food taken in the interval, 13 oz. of bilious fiiiid were extracted by a tube on the following morning, and even after the organ had been apparently emptied a splash could still be obtained to the right of the umbilicus. Daily lavage, combined with careful dieting, afforded con¬ siderable relief for the first ten days, but the loss of weight still continued. At the end of a fortnight it was noted that the patient was not so well. Vomiting occurred each night desjjite the lavage, and the right lobe of the liver had increased in size, and presentetl a small superficial nodule. Attacks of extreme restlessness alternated with periods of somnolence, and at night-time he suffered from fits of choking, accompanied by urgent dyspnoea. On the eighteenth day after admis¬ sion the bowels ceased to act, and incessant vomiting set in, which lasted for three days, and precluded the administration of nourishment by the mouth. During this period from 6 to 9 pints of thin alkaline green fluid were rejected every twenty-four hours. The urine was scanty, and assumed a dark red tint when boiled Avith nitric acid. A week later fluid was detected in the peritoneal cavity, and the patient complained of great distension after meals. A gland above the left clavicle was also found to be enlarged, and the nodule in the right lobe of the liver was more distinct. A feAv days afterwards, the temperature suddenly rose to 101° F., and he became delirious. There was no cough or expectoration, and the respirations Avere only 24 per minute. The folloAving day the temperature had fallen to 99°, but the patient Avas semi-unconscious, with a dry tongue and a pulse rate of 136. Com¬ parative dulness on percussion Avas detected at the base of the right lung, and a feAV moist crepitations Avere audible on auscultation. During the evening the temperature rose to 102°, the coma deepened, and death occurred in the early morning. Necropsy.—The anterior portion of the abdominal cavity Avas chiefly occupied by tAvo thin-Avalled sacs, Avhich lay side by side. The one on the left consisted of a dilated stomach, Avhile the other, Avhich VA^as ovoid in shape and 8 in. in length, Avith a maximum circumference of 13 in., represented the upper tAvo-thirds of the duodenum in a state of extreme distension. When the latter Avas laid open, its loAver end Avas found to be the seat of an ulcerated malignant groAvth, Avhich had so contracted the lumen of the boAvel that it hardly admitted the tip of the index finger. The retroperitoneal glands Avere much enlarged, and the liver contained four secondary groAvths. There Avas recent pneumonia in the loAver lobe of the right lung. The groAvth Avas a columnar-cell cancer. Cases have been recorded in which the whole or greater part of the dnodenuin Avas infiltrated with carcinoma, and converted into a thick, rigid tube of small diameter. The symptoms that accompany this rare form of disease are essentially those of chronic intestinal obstruction, accompanied by excessive vomiting and dilatation of the stomach. Jaundice is an inconstant phenomenon, but mehena is not infrequent. In Arrachard’s case a large mem¬ branous cast was evacuated after the administration of an aperient, and death was preceded by troublesome diarrhoea.
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