Surgery of the stomach / by Walter G. Spencer.

  • Walter G. Spencer
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Surgery of the stomach / by Walter G. Spencer. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    round. If the extravasation is confined to tlie front of the stomach, the whole is washed, wiped out and sutured without drainage. But the stomach contents may have already spread over the abdominal cavity, especially by passing down the sides into the loins and the pelvis. Yet, if decomposition has not previously existed in the stomach, the antiseptic action of the gastric juice protects the peritoneum from the immediate onset of peritonitis. All that is necessary then is to remove the extravasation from the abdominal cavity. A suprapubic incision is made and a glass tube passed down into the pelvis. Then from the epigastric incision and through the pelvic tube streams of hot water are passed until the water returns absolutely clear. Then the abdominal wounds are closed. When, however, general peritonitis has set in (and this occurs early when the gastric contents have already undergone decomposition, or when pus has escaped from the lesser into the greater peritoneal cavity), the chances of saving life are very small. According to the position of the chief collections of fluid, a glass drain may be passed through a suprapubic opening into the pelvis, or a woman may be drained through Douglas’s pouch into the vagina, or tubes may be passed from each kidney pouch out through the skin of the loins. Then the abdominal cavity is abundantly irrigated with hot water until every- thing is returned clear. The epigastric wound is sewn up and the other tubes left in position. McGillivray has this year reported two cases which recovered, the abdomen in each was found full of pus, and Douglas’s pouch contained more than a pint.'-'-' It is more difficult when the perforation is on the posterior wail and the escape is first of all into the lesser peritoneal cavity. The contents may pass by the foramen of Winslow into the general peritoneal cavity. This orifice is often closed by adhesions, and the cavity is entered below the stomach through the gastrocolic omentum. The extravasation may extend forwards over the lesser curvature and to the left between the spleen and the diaphragm. The ulcer will generally be adherent posteriorly, e.^., to the head of the pancreas, so that it will be impossible to treat it by the invagination or excision * Since writing tliis paper I have liacl the fallowing case. A gentleman, aged 6o, under Dr. .Allchin and Dr. ]3atterhain, of St. Leonard’s, having sulTered a long lime from ulceration and pyloric obstruction, had perforation at two or more points of a pyloric ulcer, with general e.vtravasation of fluid, more than a pint being found in the pelvis. He recovered after his operation, which consisted in anterior precolic gaslro-jejunqstomy by suture, wash- ing out the abdomen, draining the pelvis through a hypogastric lube, and placing gauze in contact with the pyloric ulcer through the epigastric wound. The pyloric mass forming the ulcer was so soft and rotten that it could not be touched. The patient has now gone abroad, taking soft solids.