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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    much enlarged, and a succussion splash may be obtained as far outwards as the right mammary line, or even in the lumbaT region. This latter phenomenon is apt to be ascribed to dilatation of the pyloric region of the stomach, but is really due to the duodenum, which, being greatly enlarged above the stricture, forms a distended sac behind and to the right of the pylorus. When the disease merely forms a ring round the bowel, no tumour can be detected by palpation, but if the growth is accompanied by enlargement of the retroperitoneal glands, or has infiltrated the pancreas, an indefinite hard mass may be felt to the right of the umbilicus. Exploration of the stomach with a soft tube elicits three facts of considerable importance. In the first place, it may be observed that, after the organ has been apparently emptied, a fresh gush of fluid occurs when the patient coughs or inclines his body to the left side, a phenomenon wdiich is obviously due to regurgitation of the contents of the duodenum through the incompetent pylorus. Secondly, after the stomach has been evacuated, a succussion splash may still be obtained over a limited area to the right of the navel, owing to the presence of fluid in the duodenum. Finally, after the stomach has been washed out overnight, and no food taken in the meanwhile, a quantity of bilious fluid may be extracted in the morning. These three phenomena, taken in conjunction with the physical signs afore¬ mentioned, render the diagnosis of stricture of the third part of the duodenum almost a matter of certainty. Case 3.—A carpenter, Jiet. 56, was admitted into hospital with the following history. He had always been in good health until five months previously, when he was suddenly seized with a bilious attack, and vomited for two days. Since that time he had suffered from flatulence and discomfort after meals, loss of appetite, and steady emaciation. Latterly he had vomited once or twice each day, and had become very weak. The bowels were confined, and micturition was accompanied by a scalding pain in the penis. On examination, the patient was found to be very thin and ansemic, with a purple flush on either cheek, which was stated to have developed during the course of his illness. The pulse was small and compressible, the tongue covered with a creamy fur, the breath offensive, and the temperature sub¬ normal. The bowels were confined, but the stools contained bile. The lower border of the stomach extended nearly 1 in. below the level of the navel, and its pyloric portion appeared considerably dilated, as a succussion splash could be obtained as far outwards as the right anterior axillary line. The organ could be seen to contract slowly from left to right. The liver was enlarged, and the lower edge projected 1 in. below the costal margin. Tliere was neither ascites nor jaundice, nor could any localised tenderness or tumour be detected in the abdomen. The thoracic viscera were normal. The vomit during the first night in the hospital amounted to 18 oz., and consisted of an alkaline opaque fluid of a deep green colour, which deposited a flocculent precipitate on standing. Gmelin’s test gave a positive reaction, and, after the addition