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.

    12/18 (page 12)
    oxLensive'iiifl;iniinali(^u in the siil)inucous and muscular coals of Ihe inlestiiie. Tlie .iiiflaumialory changes may extend to the serous coat and to the under surface of the liver, fn |)rocess of time Ihe ulcer heals and hy Ihe suhsetiuent cicatrisation of lln^ inllarnma- lory ])rodu(ds lh(“ duodenum is either narrowed or it is constric- ted'hy the surrounding adhesions. I'Jie adhesions may not only affect Ihe duodenum hut they may also involve Ihe liver, the gall bladder, the pancreas and such large blood vessels as the abdo- minal aorta, the hepatic artery and the porlal v(dn. Smdi a jiatient presimts himself as a man between 40 and (50, looking older than his years. Thin and haggard he tells you that he is a martyr to indig(‘slion and that fur months past he has suffered atrocious l)ain in his stomach which is relieved hy vomiting. He has dieted himself in (‘very possible manner, he has made all kinds of local ap])lications lo his stoma(di, he has visited all sorts of watering places and he has gone in vain from one physician to another se(‘kiiig a cure. I•lxalnination shows him to he a mere hag of bo- nes. badly conslipal(*d with cold (‘xtrendti(‘S and a listless, deje- <d(‘d aspect, llis abdomen is loose, the suhcutaneous veins may h(‘ eiiUrccd and there* is visihh' peristalsis from left to right in th(“ (“piiiastric region. I’alpation and percussion tell of a greatly dilated stoimudi and a tumour may sometimes he felt iu Ihe neigh- houi'hood of tin* pylorus, kor a moment you thiidc of cancer of th(‘ pylorus or galhhhuhh'r and you (pu'stion llu^ i>atient a liltle more clos(‘ly. lh‘ is sure* that Ik* has h(*(*n suffering for years, for so long, in fact, that In* hardly recollects tin* beginning of his trouble*. .V f(*w w(*ll-direcl(*d (m(pnrie*s may elicit that 2d efr 30 • y(*ars ago, when he was a young man, he once or twice brought up a large* epianlity of Idood without serious pain or discomfort or that he had an illness which no one^ seemed lo know much ahoid. He was tre'ated for gallstones or for a|)p(*ndicitis or sim|)ly for «liver.» The attack was abdominal, was itaiiifid and kept him in bed, hut the exact details have long since passed front his mind and for some* years he was as healthy a mati as eiver. This is a case of duodenal ohstiTiclion re*sulting from cicatrisa- tion of an old ulcer, Ihe irritation of whiedi caused inllammatory thickening of the* surrounding [)arts or of the duodenal walls. How many patients have been allowed to die of such a condition in the h(di(*f that they had malignant disease of the stomach no one can tell, hut every i)alhological Miiseuin contains several specimens- of simple eluodenal constriction. He*re is such a case in detail: