The symptoms, treatment and sequelae of non-malignant duodenal ulcer / par D'Arcy Power.

  • Power, D'Arcy, 1855-1941.
Date:
[1906]
Catalogue details

Licence: In copyright

Credit: The symptoms, treatment and sequelae of non-malignant duodenal ulcer / par D'Arcy Power. 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.

    11/18 (page 11)
    f- -I perforated duodenal ulcer may be mistaken for pneumonia, for iippendicilis or for suppuralivm periiotiitis froin any other cause. (H) Non-i’i:rf()K.vtin(; ulchr Tlie second group of cases wliere there' is a duodenal ulem’ ■ Avilhout perforation is even more interesting than tine perforating variety which has just been considered. The diagnosis is more dif- licult and the seeiuehe demanding surgical treatment are no less eirgent tliough they may he more remote'. As may he gathereel from what has been saiel of perforateel ule-eis, the signs of :i duoelenal ideer may he absent e>r wholly inconspicuous anel in suedi eaises no eliagnosis is possible, lii some cases the' jeatieut e-eemplains of a continueel pain in the aledomen which he can neither localise nor account for. He keeps his bed for a few elays and then feeling bet- ter goes about again saying that he has hael a hael bilious attack. If he is nervous about himself or shoidd the pain have been se- vere, he seeks medical advice and is treated for gallstones, renal colic, or appendicitis, lint the exact nature of his illness is i)roha- hly not recognised unless he vomits a considerable quuntity of blood or has a sharp attack of mehena. Kven then the case is thought to he one of gastric ulcer, unless an abdominal section is performed and the stomach is found to he healthy. 1 do not know how a diagnosis can he established in the ]>resent slate of our knowledge, hut it is of no practical importance, for in the majority of cases the ]iatient recovers from the attack •j . unahied by art or if the bleeding he suflicient to need an explora- •:i tion tin? surgeon pi'rforms a gastro-jejunostomy, whether the nl- > f cer he situated in the stomach oi’ in the duodenum. 1 have tried to recognise the condition by the charach'r of the bleeding, by the time of the occurrenc.e of pain after taking food, by the cha- racter of the material vomited and in many other ways, hut al- ways without success, for what is trm^ and seems a valuable sign in one patient is worthless in another. I helievu', therefoia', that there Is no pathognomonic sign of a non-perforating idcer of the duodenum whilst the uhawation is in |)rogress. Co)istri(;(io)i, of llta (hiode)in»i. — Hut if a non-perforating duo- denal ulcer offers very few signs by which its presence' may he detecl(;d, it may have seepu'la; of the gravest character. The ulci'r is usually single*, anel is situateel in the first [eart of the eluoele- num, hut like a gastric ulcer it is very chronic aiiel may e-anse