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.

    8/18 (page 8)
    I therefore opened tlie abdomen in the rigid, iliac region and found tlie ajipendix normal. Gas issued from Ihe abdominal cavity as soon as the peritoneum was in- cised and there was gush of alkaline' fluid which did not smell hut was clearly hile- stained. The end of the ileum was inflamed in patches which seemed to correspond with Peyer's patches. The clear alkaline fluid which escaped from Ihe peritoneal cavity told me that the perforation had occurred much higher up the alimenlarv canal. I theri'fore plugged the iliac wound and opened the abdomen in the middle line above Ihe umbilicus. The stomach was found to he normal, hut a jKwforalion was discovered in the duodenum and on its anterior surface, measuring about an eight of an inch across. The hole was closed wilh two layers of Lendierl's sutures. Drainage tubes were inserted at the upper and lower ends of the median incision » as well as in the iliac wound. The patient bore the operation well, making a steady and uneventful recovery. He left the hospital on the 48th day after the operation. It is now three years since he was under my care. I have seen him at intervals of a year and he always says that he is a healthy man with nniiujiaired digestion and able to follow Jiis original occupation. ihcmorrhaqe. The luemorrhage in some cases of duodenal idcer is a characleristic symploiu. [t. is sudden, painless ;ind very considerable in (jiianlity. It seems to he due to erosion of the lar- ge arteriiil trunks which lie outside the duodenum —the suiterior pancre:itico-du(.)denal artery In'ing the mosi commonly affected, though the gasiro-duodenal, the pyloric, Ihe gastric and the ])an- creatica magmi as well as tin* superior pancreatico-duodonal vein have been found ulcerated. 'Fhe luemorrhage m;iy he so severe as to he fatal at once, more often the patient is hltinched or he may become ftiint without knowing the cause. 'Fliis may happen on more than one occasion and as the hiemorrhage is conceaUnl the cause is only recognistMl by tlu^ sidjse(iuent passage of large tarry motions. In other cases the patient may have luemateme- sis insh'ad of meliena or both in:iy he jtresent. Mere is an example of smdi a case: A mail agcil 81, a printer’s labourer, was admitted into .St. Bartholomew’s Hospital under my care on .M;iy IHlh. l‘JU4, and was ilisch;irged on .tune 17 Ih. The patient had been trealeil iu Luke ward by my colleague dr. llerringham since April 22nd. for pain in the lower part of his abdomen ami vomiting. The pain had lirst been fell six months previously and had gradually become worse until on gelling out of bed one morning nine weeks since he had felt faint and vomited -a (juart of dark blood all in lumps. He was at borne for five weeks after this and was then in the infirmary for three weeks. On Ajiril- 19lh. he retched after food and on .^iiril 20th. he vomited na pint of blood■> after food. There was no hyst.o- ry of inehena and the patient said that he had never had any illness of importan- ce. Two years ago he was in .Australia and Canada, lie drinks one or two pints of beer a day and smokirs a little, lie lias never had venereal disease : is married and has two children living: Ihe last two were stillborn. His father died of acute alco- holism at the age of 48, his mother in childbed.