The place of the Murphy button in gastro-enterostomy / by Willy Meyer.

  • Meyer, Willy, 1858-1932.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: The place of the Murphy button in gastro-enterostomy / by Willy Meyer. 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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    Diagnosis: carcinoma pylori (Dr. Einhorn). Laparotomy Au- gust 23, 1894 (German Hospital). Pylorus overlapped by the liver, but is not adherent to it; is strictured by a tumor. Multiple infiltrated glands in the greater omentum. Upper portion of je- junum easily found, as in the previous case. On gliding with the fingers downward to reach a coil with a long mesentery, a meta- static growth which surrounds the gut in the shape of a circular ring is encountered at a distance of twenty-six inches from the pylorus. A coil about seven inches farther down is selected for anastomosis and easily attached to the anterior wall of the stomach with the help of the button. No additional sutures. Recovery uninterrupted until the eighth day after the operation. Then sudden sharp gastralgia, defined by patient as an oppressive heavy feeling in the region of the stomach. Vomiting of large masses of a thin fluid of slightly faecal odor. No rise of tempera- ture; constipation; no passage of gas. Lavage of stomach; cal- omel (one-tenth grain in refracta dosi); bowels move. Prob- able diagnosis of compression of transverse colon excluded. Vomiting and pain continue. Diagnosis: Button has most probably dropped into the stomach. Under careful nursing patient recuperated slowly. Pain disappeared after about eight days and did not return. Patient soon out of bed. Lately fre- quent coughing spells with expectoration. Examination reveals tubercle bacilli in the sputum (hospital infection). Patient dis- charged October 10. Appetite good; all kinds of food are taken and relished; no vomiting. Has gained sixteen pounds within the two weeks. Button not yet passed. Improvement does not last long. Frequent attacks of coughing, night-sweats, fever. Readmitted to hospital November 6. Exitus lethalis November 12. Post mortem: No compression of transverse colon; anasto- mosis round as if punched out with a forceps; appears a little wider than the circumference of the button; border soft; not the slightest contraction ; button within the stomach. Gastric mu- cosa shows no trace whatever that could be referred to the long presence of the button. Acute cheesy pneumonia of the entire right lung.- Case III.—D. H., male, aged thirty-eight years. Complains for the last year and a half. Palpable tumor somewhat to the left of the median line. Symptoms of pyloric obstruction. Very emaciated. Operation October 3, 1895. At the pylorus a nodular