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.

    7/18 (page 7)
    I- • I ri.ci';i<E siN;r;.r. m; nroi)K.\r.\i 7 F., Ihe pulso was 120, the respiral ions (iO. At 12 iniilnight tliere was slill no mate- rial ehange in Hie condition of (he patient, whose temperature was 99<>,8 K., pulse 120, respirations ()()-70. A little liijuid had been vomited. .At 1 a. m. the alHlomen was distended and the patient wa.s slightly collapsed with a imlse of 144 almost running. At 2 a. m. the patient was still more collapsed. 1 then saw him for the first time and at once determined to open his ahdomen. Liquid escajied as soon as the peritoneal cavity was opened and on drawing the stomach into the wound a liole was found hi the duodenum large enough to admit a full sized probe; tlu're was a considerable deposit of lymph all round Ihe margins of the aperture An aHempt was made to close the opening with Lemberl's sutures, but the oi>eration was very diflicult, owing partly to Ihe awkward position of the nicer and partly to the rotten state* of the tissues in the neighbonrhood. Four sutures were passed and it seemed as though the opening had been successfully closed. During tbe suturing large quantities of a thin liquid kept welling up from Ihe perforation until th<^ last suture had been inserted. Tbe peritoneal cavity was then cleansed and afterwards •closed The patient bore tbe operation badly and bis ])ulse at the'end was hardly perceptible lie died at 7. .80 a. m. A post mortem examination at three p. m. on the same day showed that the |ieritoneum was acutely inflamed, its endothelial aspect being cov ered with a layer of librino-pnruleni lymph. There were collections of purulent matter at Ihe bottom of the pouch of Douglas, in (he lumbar region and in Ihe right sulqihrenic s[)ace which was almost completely shut off from Ihe rest of the peritoneal cavity. The beginning of the duodenum at tbe iqqier and jiosterior part was the seat of a coni- cal ulcer wliich measured half an inch in diameter. It hail sharpiv. cut edges but there was no intiltration at tlie margin The lloor of tbe ulcer had perforated but the sutures were not accurately applied as water and intestinal contents I'asily passed through. Iho particular interest of this case lay in tlie fad that the localised perifoiiitis must have lasted a much longer lime than, the sudden onset of the symptoms would have led one to suppose, whilst the symiitoms when they appeared wc're so obscure as to make it seem that the patient was suffering from pneumonia ra- ther than froin peritonitis. It is farther interesting because it is a record of the course taken by a case of ]ierforated duodenal ulcer which though carefully watched was practically untreated. Ihe following case illustrates how easy it. is to mistake a perforated duodenal ulcer for an acute attack of appendicitis; A bookstall keejjcr, aged 2(i, was admitted into St. Bartholomew's llos])ilal under my care snlTering from abdominal pain and sickiu'ss. He said tbal he had suffered from other attacks of .similar pain, but this was much more severe, and had begun suddenly at 7 p. m. on Ihe previous day. Tbe abdomen wben I saw him at 10 a. 111. tlie next morning was hard, tense and |iainful. Tbe temperature was ■)7»,2 1'. and tbe pulse 112. He localised his pain over Ihe right iliac region which was lender and full, the rest of the abdomen moving during respiration. I thought that he was suffering from acute a|q,endicitis which had ended in perforation and