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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    heralded by repeated chills and intermittent pyrexia. It is worthy of notice that the coloration of the skin is seldom very intense, and that the bronzed or olive tint that accompanies malignant disease of the bile duct is seldom observed, while not infrequently the jaundice alternately deepens and fades, or appears to be favourably affected by saline aperients. When ulceration occurs, the growtli which obstructed the orifice of the duct mav be quite destroyed, and the bile once more find a free exit into the bowel. Under these conditions the icterus either disappears completely, or the urine alone continues to give indication of the presence of bile in the circulation. The subsequent course of the disease depends upon the extent of the growth and the development of complications. As a rule, the jaundice 'Continues with varying intensity, and the patient steadily loses flesh and strength. The appetite is often better preserved than in gastric cancer, but there is usually great distaste to fats, and sometimes excessive thirst. The tongue is foul, pain and flatulence are experienced two or three hours after every meal, and constant nausea or eructations of sulphuretted hydrogen are a frequent source of complaint. Vomiting is seldom absent, and, at this stage of the disease, usually occurs once or twice a day. The ejecta are copious in quantity, and consist of a brownish sour-smelling fluid, which deposits a thick sediment of undigested food, but is usually devoid of free hydrochloric acid. Notwith¬ standing the presence of jaundice and the absence of bile from the stools, the vomit occasionally exhibits a bright green colour. Haimatemesis is comparatively rare, but altered blood is not in¬ frequently seen in the evacuations. On examination, the epigastrium is found to be slightly dis¬ tended, and there may be some degree of rigidity of the right rectus muscle. The liver is invariably enlarged, and its lower border extends for an inch or more below the costal margin. Careful palpation will also reveal the presence of a distended gall bladder, in the form of an elongated, elastic tumour, which is attached to the under surface of the liver, and is capable of slight lateral displacement. At first it is situated near a vertical line drawn from the tip of the ninth rib, but, as the liver enlarges, it may be pushed several inches to the right. A tumour due to the intestinal growth can seldom be detected, but if the pancreas, retroTperitoneal glands, or the omentum are invaded, a hard, nodular, and painful mass may be felt in the region' of the navel. En¬ largement of the stomach is always present, and in many cases the contractions of its hypertrophied walls are visible through the abdominal parietes. Although death usually ensues from inanition at the end of six to eight months, it may occur at a much earlier period from toxaemia or other biliary complications. Case 1.—A woman, get. 54, was admitted into the London Temper-