Relation of lesions of the small intestines to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole.

  • Lewis Gregory Cole
Date:
1914
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Licence: In copyright

Credit: Relation of lesions of the small intestines to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole. 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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    production of postpyloric ulcer. As has been stated in previous communications the cap has the function of a reservoir or second stomach, where it is probable that the finishing touches of proteid digestion are applied to the small amount of chyme thus isolated from the bulk of food in the stomach. That the strength of the gastric juices is intensified in the cap may be inferred from the presence here of the glands of Brunner and Lieberkuhn. If duo- denal peristalsis ceases after most of the chyme has been withdrawn from the stomach, and an appreciable amount of chyme remains in the cap for a much longer period of time than usual (Fig. 11), is it not reasonable to suppose that this chyme becomes hyperacid from oversaturation with the juices of the secretory glands of the cap? For if it is imprisoned in the cap without being diluted by weaker chyme from the stomach or neutralized by alkaline solutions administered for this purpose an excess of acid must result. Is it not likely, therefore, that a prolongation of this condition will destroy the muscular coat, particularly if the mucosa has been bruised or broken by solid particles of food or by instrumentation? If this supposition be correct, any condition which diminishes, paralyzes, or inhibits duodenojejunal peristalsis will be a pre- disposing cause of postpyloric ulcer. It is also important to note the far-reaching results of dilatation of the descending and horizontal duodenum, which may be filled by an active gastric peristalsis and not evacuated for a long time in consequence of the inhibition of duodenal peristalsis. The over- distended lumen offers no resistance to the expulsion of chyme through the duct of Wirsung into the ampulla of Vater (Fig. 12), and perhaps even into the common or cystic duct. This indicates a direct source of gall-bladder infection.6 Ileal Dilatation a Cause of Inhibition of Duodenal Peri- stalsis. Ileal stasis has been the all-absorbing problem of late among clinicians and surgeons interested in gastro-intestinal lesions. Although roentgenological evidence has played an im- portant role in the diagnosis of this condition, interpretation of the findings has been influenced in many instances by the pre- conceived theory which the surgeon or practitioner was trying to prove. Case’s roentgenological studies of the ileocecal region are an exception to this rather general rule.7 Careful observation of the entire gastro-intestinal tract at different periods after ingestion has shown that the inhibition of duodenal peristalsis during the later stages of digestion is usually associated with a distention or dilatation of the terminal portion of the ileum. 6 A like duodenal dilatation may also be caused by an organic obstruction at the duodenojejunal junction, by pressure from the mesentery vessels, or by adhesions. 7 Case, X-ray Observations on Colonic Peristalsis and Antiperistalsis, with Special Reference to the Function of the Ileocolic Valve, Read before International Congress, London, August, 1913; X-ray Studies of the Ileocecal Region and the Appendix, Amer. Quart, of Roent., November, 1912, p. 77.
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