Gastrostomy in malignant disease of the oesophagus / by T. Whitehead Reid.

  • Reid, T. Whitehead.
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Gastrostomy in malignant disease of the oesophagus / by T. Whitehead Reid. 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.

    1/8
    [Reprinted from St. Bartholomew’s Hospital Reports, Vol. XX.] GASTROSTOMY IN v MALIGNANT DISEASE OF THE (ESOPHAGUS./ BY T. WHITEHEAD REID, Esq. The treatment of cancerous obstruction of the oesophagus by permanent catheterism applies to cases seen at a far earlier stage than those now under consideration. The retention of a flexible tube passed through the mouth beyond the seat of stricture should undoubtedly be tried in cases where the patient is able to swallow liquids at all; but too much caution cannot possibly be exercised in dealing with these can- cerous strictures. A red rubber sound and the lightest of skilled surgical bauds should alone be allowed; and should the patient be under the influence of an anaesthetic, far more care is required even than that exercised in the treatment of urethral strictures under similar conditions. The pericardium has been perforated, a bronchus entered, or a fatal septicaemia induced by the passage of hard bougies in even dexterous bands. One has seen post- mortem cases of ragged ulceration of the oesophagus, where, bad a bougie been used, the result must have been traumatically fatal, and yet during life with no indication to lead one to suspect the existence of such extensive disease—cases where one would have dreaded to have employed catheterisation. Bronchial symp- toms most certainly counter-indicate any attempts of the kind ; but often discretion is better than counter-indications. It may be true that no stricture is really impassable to the minutest whalebone bougies extant (half a millimetre in dia- meter), but it is certain that many cancerous occlusions of the oesophagus contain dangerous ulcerations in close proximity to vital parts peculiarly intolerant of the finest bougies. I would prefer to make a capillary puncture into the stomach itself to guiding a bougie through the wall of an ulcerated oesophagus.