Primary carcinoma of the duodenum / by W. Soltau Fenwick.

  • Fenwick, W. Soltau (William Soltau)
Date:
1910?]
Catalogue details

Licence: Public Domain Mark

Credit: Primary carcinoma of the duodenum / by W. Soltau Fenwick. Source: Wellcome Collection.

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    / The disease may occur at any part of the duodenum, but is most frequent in the second or vertical portion, where its seat of election is the mucous membrane covering the biliary papilla. Out of fifty-one cases, the first part was affected in eleven, or 21’5 per cent., the second in twenty-nine, or 57 per cent., and the third in seven, or 13-5 per cent., while in the remaining 8 per cent, the disease involved the whole or greater portion of the bowel. Etiology.—Like simple ulcer in the same situation, a malignant growth is more frequent in men than in women, no fewer than thirty-seven out of the fifty-one cases being of the male sex. The average age at the time of death was 63 years, the mean duration of life in the male case being 52 years, and in the female 54 years. ILathan-Lorrier, however, found that in rather more than one-third of the cases he collected, the patient was over 7 0 years of age. The disease is apt to follow a chronic ulcer; at least ten instances in which this sequence of events occurred having been placed on record (Perry and Shaw, Nathan-Lorrier, Letulle). In other cases, and more especially in women, the car¬ cinoma appears to be associated with the presence of gall stones. Symptomatology.—The symptoms of duodenal cancer vary according to the situation of the growth. When the first or horizontal portion of the bowel is affected, the patient presents all the indications of pyloric stenosis, and a differential diagnosis is extremely difficult. Disease of the second or vertical part is apt to involve the orifice of the common bile duct, that its location may often be determined during life by the coexistence of jaundice and enlargement of the liver, while a stricture of the duodenum below the biliary papilla is usually attended by bilious vomiting and the presence of pancreatic juice in the ejecta. It is therefore convenient to consider the clinical aspect of the disease, according as it is situated above, around, or beloiv the biliary papilla. 1. Carcinoma above the biliary papilla (supra-ampidlary or parapyloric camcer').—In this position the growth may either form a ring round the bowel, just below the pylorus, or produce a deep ulcer with overhanging edges, the base of which is adherent to the liver or pancreas. In both cases the lumen of the intestine is considerably diminished, though never entirely obstructed. The complaint is chiefly encountered in men of middle age, and some¬ times follows simple ulceration. The initial symptoms are somewhat indefinite, and principally consist of discomfort and flatulence after meals, acidity, loss of appetite, and general debility. There are also slight but pro¬ gressive loss of flesh, and marked pallor of the mucous mem¬ branes. After a month or two pyrosis makes its appearance, and is followed within a short time by vomiting. At first the emesis may only occur about once a week, and is accompanied by amelioration of the other symptoms, but it gradually becomes more and more frequent, until finally it takes place once or twice every