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.

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    '■ ■ _ r' ■■ ‘ . ■ ■ '^.-. S' \ () d’arcv powkk alelv tho.palieui is still loft imtreatod, oitlier beoauso an inoor- rocl diaiinosis has been made or because bo does not apply for relief, llie pain asain becomes urgent, but is now felt in Iho riglit iliac fossa which becomes especially tender, full and motionless. The patient shows the ordinary signs of peritonitis, he again be- comes collapsed, his puls(‘ (piickens, his temperature rises and he dies usually with a diagnosis of ajipendicitis. The errors in diagnosis are (piite excusable in those who have not already had to treat a case,of perforated duodenal ulcer and in those who are only calhul in to see a i)alient in Ihe later stages. d’h(‘ initial shock caus(‘d l)y the sudden perforation is ge- n('rally sufficient to indicah' thac some grave' catastrophe has oeamrred and has overwhelmed lh(' peritoneum. The symptoms are not epiite like those of a perforated gasti'ic ideer, because the duodenal contents are more digested and less acid than those of Ihe stomach and liu're is conse'epn'nlly less irritation. The syni])' toms snbside llu'refore for a linu' and Ihe lliiid poured out by Ihe duodenum slowly acciimulatc's in the iliac fossae and more in lh(' right than in the h'fl. TIk* onset of peritonitis demands an examination of Ihe abdomen and as tin* patient mtw locales bis symptoms to Ihe lowt'r part of his abdomen it is easy to treat lb(‘ case as one of appendicitis. Here are two cases illustrating I hese mistakes: — .\ |i(irl(‘r ;igfil 41 was ailmillcd iiilu .St. Hat'IlKiloinew's lluspilal saying lliaf 111' was at work ami ipiitc wi'll until 11 a. in. wlicn iu' was snilili'nly altackoil with jiaiu iu his C|iigastriuiu. Tlic I'ain continiu'il and he voinitcd several tiiiios hehfre coming to the liospilal. lie had )iassed no llatus since the pain began ; his bowels had been well open on tlie previous day. Me was a l“inperafe man and was sure that he liad never .sulTi'red fr-mi indigestion. .\t 2 p. m. Ihe patient was reported to 1)0 a well-nonrished man in obvious pain. Mis tongue was clean and moist: his res- pirations were very shallow and (10 in Ihe minute: his pulse was of fair volume and tension, regnlar and lUO ;i minute. In the chest Ihe percussion nole was im- jiaired at llie right base and the entry of air at the base of the right lung was weaker than at the left. .\o additional sounds were heard by auscultation. The ab- dominal |)ain was not localised but llie patient complained of it cliiefly over Ihe upper half and down llie rigid side. The abdomen was not distended but moved vi'ry little during respiration. Tlie movement, howe\er, was equal all over, though the abdomen was hold somewhat rigid. It was tender and tympanitic everywhere except that the liv'i'r dulness was present. .N'olhing abnormal could be fell. II was impossible at tliis time to make any delinilo diagnosis and tbe surgeon left directions Ihat Ihe |)alienl should lie carefully watched on the assunqilion that he was sulTe- ring from pulmonary rather than abdominal trouble and most likely from pneumo- nia. There was no delinit i hange al (i p. uf., an enema sapouis had been retained, but in spile of fomeidalions Ihe pain was unrelievi'd. The temperature was