Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger.

  • Billings, Frank, 1854-1932.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    the genitalia. ]^ut—as has been taught us by quite analogous cases— something else might be present, and it is advisable to keep these other possibilities always in mind. What conditions must be considered here? Basis of support is given by two factors: The very insidious onset, and tlie seat of the stenosis in the lower portion of the small intestine. Both these facts coincide with the assumption of cicatricial stricture or neoplasm. In fact long experience has taught me to formulate the following law^: When there is an. unquestioned stenosis of the ileum, and absolutely no point hy which we may recognize its anatomical nature, we should primarily con- sider cicatricial stricture following tuberculous ulcers of the ileum, even although no other evidence of tuberculosis can be determined. I have seen conditions exactly as in this case; i. e., stenosis of the small intestine in women in whom j)eritoneal bands originating from the genitalia were palpable, yet nevertheless, at the operation or. autopsy, not these but cica- tricial strictures after healed tuberculous ulcers of the ileiun were shown to be the cause of the stenosis; or, a small neoplasm, either carcinomatous or tuberculous, not palpable, situated in the lowest portion of the ileum or at the ileo-cecal valve, might also be considered. From this framework the diagnosis must be evolved; we cannot express ourselves more definitely or more carefully. Our diagnosis, tlierefore, in this case is as follows: Peritoneal constriction or volvultis, or a tuberculous cicatricial stricture or neoplasm {carcinoma, tuberculoma),^ PROGNOSIS The prognosis of constriction of the intestine is always serious although not always equally so. The gravity is determined less by the seat than by the nature of the obstruction. In some forms, although naturally very rarely, spontaneous recovery may result; a benign polypoid neoplasm, even an invaginated portion of the intestine, may be thrown off, an exudate which causes pressure may be resolved, a uterus in abnormal position may be replaced, and thus the cause of the stenosis is removed. But these are all exceptions. Without treatment stenosis almost always causes serious consequences. If no eomplica^tions occur, the course of a benign stenosis is as follows: 11 here include the following: Laparotomy revealed the existence of pelvic peritoneal bands; but these were chiefly found in the large intestine, and there was no causal connection with the stenosis of the ileum. In the ileum not one but two stenoses were found, removed about 6 cm. from each other. A portion of the intestine about 13 cm. in length was excised; examination revealed two ring-shaped, coarse, fibrinous, cicatricial stric- tures. The mesentery belonging to this coil of ileum contained glands which were hard and the size of a hazelnut; microscopic examination revealed tubercular disease. Accordingly the intestinal strictures, also, must be looked upon as originating from tuberculous ulcers.