Negative diagnosis of surgical lesions of the stomach and cap / by Lewis Gregory Cole, M.D. Professor of Roentgenology in Cornell University Medical College.

  • Cole, Lewis Gregory, 1874-1954
Date:
1914
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Licence: In copyright

Credit: Negative diagnosis of surgical lesions of the stomach and cap / by Lewis Gregory Cole, M.D. Professor of Roentgenology in Cornell University Medical College. Source: Wellcome Collection.

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    surgical findings corresponded with the Roentgenographic findings in every essen¬ tial detail, but in one case they differed to such an extent that it was impossible to ex¬ plain the discrepancy. In most of the cases the incision was made directly over the pyloric end of the stomach, and in all cases the stomach and duodenum were examined through the laparotomy wound. The technique by means of which our con¬ clusions were reached has been fully de¬ scribed in previous communications.* An examination less complete than the one pre¬ scribed may suffice in a great majority of cases, but abbreviated methods lead to erroneous diagnoses in a sufficient number of cases to cast discredit on the Roentgen method and to rob it of the remarkable de¬ gree of accuracy which it can attain. There¬ fore I beg of you as Roentgenologists—do not apply the diagnostic principles described in this and previous communications to any¬ thing less than the complete serial examina¬ tion. Gastric cases may be divided into two classes with respect to a negative diagnosis of ulcer or carcinoma of the stomach or cap — (1) those which unquestionably present no unusual Roentgenographic findings, and (2) those presenting direct or indirect Roeiitgenographic evidence of a spasmodic lesion. The best illustrations of the first type of cases are found in symptomatically normal patients examined for experimental purposes. There is no difficulty in making a negative diagnosis of cancer or ulcer of the stomach or cap in cases of this kind, as the entire series of Roentgenograms shows the stomach and cap well distended and both surfaces of the pyloric sphincter clear-cut and well defined. Naturally such diagnoses are not proven by surgical procedure. Most cases however come under Class II. They have or have had more or less symptoms re¬ ferable to the stomach and cap. Such symp¬ toms, particularly “hunger-pain,” are associ¬ *Amer. Jour, of the Med. Scien., July, 1914, Vol. cxlviii, No. 508, p. 92. **Amer. Jour, of the Med. Scien., July, 1914, Vol. cxlviii, No. 508, p. 92. ated with spasmodic contractions of the stomach, pyloric sphincter or cap. These spasms present definite Roentgenographic findings, i. e., either direct evidence of the spasm itself or the results of continuous and repeated spasm, a condition already fully de¬ scribed in an article on the Relation of Lesions of the Small Intestine to Disorders of the Stomach and Cap.** They manifest an appearance simulating organic lesions from which they may and must be differenti¬ ated, lest the operative procedure indicated for a surgical lesion be performed at the site of a reflex spasm of unknown cause. The eight cases about to be described exemplify the marked discrepancies so often observed between the clinical and Roentgenographic findings. Fig. 1—Case XXVII. For eighteen months this patient had suffered with pressure from gas. In the last six months she had complained of acute epi¬ gastric pain, perpetual belching and some re¬ gurgitation of bile. Attacks were almost al-i| ways accompanied by prolonged vomiting, at one time for seventy-two hours. There was an entire loss of appetite and constan diarrhoea. Roentgenologically no gastric or Fig. 1. Stomach Normal—Colonic Adhesions. duodenal lesion was found. In the Roent¬ genograms of the colon a loop of sigmoid was observed to lie in close proximity to an extremely prolapsed caecum and ascending