Diseases of the stomach : including dietetic and medicinal treatment / by George Roe Lockwood ... ; illustrated with 126 engravings and plates.

Lockwood, George Roe

Date:: 1913

Credit: Diseases of the stomach : including dietetic and medicinal treatment / by George Roe Lockwood ... ; illustrated with 126 engravings and plates. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$and duodenum no longer contained any bismuth; the greater part of it was found to be in the knver coils of the ileum in the pelvis. The cecum also occupied the pelvis and contained a quantity of bismuth, while a small amount was already present in the ascending and trans- verse colon. Twenty-seven hours after the bismuth meal there was still some bismuth in the lower end of the ileum, and the most advanced portion had reached the sigmoid, thus the sojourn of the bismuth in the small intestine was more than three times the normal. Diagnosis.—The diagnosis is suggested by the dependence of the pain on the upright posture and its relief by rest, as well as by coexisting phenomena of intestinal stasis, indicated in the history of Jordan's patient. Treatment.—The treatment, properly speaking, should be surgical. The question of the propriety of ileosigmoidal anastomosis as advocated by Lane is still .sub judicc, with perhaps an increasing reluctance on the part of conservative surgeons lightly to undertake the task. It would be proper, howe\er, if obstructiA'e duodenal kinking appeared as a constant feature, either to perform gastrojejunostomy with duodenal inclusion, or to straighten out the kink by fixing the first portion of the jejunum in position by suture. The operation which seems to be growing in favor, though still sub judice, is exsection of the cecum, ascending, and a portion of the transverse colon. Chronic Arteriomesenteric Constriction.—The root of the mesentery containing the superior mesenteric bloodvessels passes from behind forward to lie across the duodenum, compressing it against the verte- bral column. A normal pressure is always maintained at this point, but so slight as to be easily overcome by duodenal contractions, so that'no actual obstructing compression results. In some instances, however, causes which produce mechanically a downward traction on the root of the mesentery may result in actual duodenal compression. The relationship between arteriomesenteric constriction and gastrop- tosis has been considered under the latter heading. Under acute dilatation will be found a full description of the relationship between this disease and duodenal constriction by a taut mesentery. Aside from these cases there is a clinical grouj) characterized In- recurring attacks of pain and duodenal regurgitation, in which arterio- mesenteric constriction can be demonstrated by surgical exploration. The patient usually gives a long antecedent history of obstinate constipation. After a variable period of time there occur attacks of ])aiii, nausea, and xoniitiiig, tlie vomited matters l)eing ])r()fuse and coiitaiiiing bile aixl other constituents of duodenal secretions.$