Duodenal ulcers in infancy / L. emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Duodenal ulcers in infancy / L. emmett Holt. 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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    that the disease has been recognized only at autopsy in the great majority of the cases reported. There is one method of diagnosis which I believe is likely to assist materially in these very obscure cases—the passage of the duodenal catheter. An opportunity to try it was afforded in one of my cases (Case 2). Ulcer was not at first suspected in this patient, but on account of the intense jaundice Hess’s duodenal catheter was intro- duced to see if the presence of bile in the intestine could be demonstrated. On its withdrawal the catheter was found to contain a clot of blood, but no bile. Although the duodenal catheter had been passed many times before in other patients, blood had never been seen under such circum- stances. We did not, therefore, believe it could be the result of trau- matism. The suspicion of duodenal ulcer was strengthened by the presence of blood in the stools. Given a young infant with intestinal hemorrhage and showing no other symptoms of colitis, intussusception, polypus, etc., the introduction of the duodenal catheter is not only justified, but indicated, and it may gi^'e, as in my own case, very definite information on whicii in the future successful treatment may ]30ssibly be based. I know of no other means of diagnosis which will tell as much. The possibility of doing harm by the catheter cannot be denied; but the risk in my opinion is so slight that it may be ignored. TROGNOSIS In a condition so difficult of diagnosis and where the great majority of the cases are recognized only at autopsy, there are but few data avail- able for prognosis. That such cases may recover seems certain from the observation of Schmidt, who found at autopsy in an infant dying of some acute infection at 5 months the cicatrix of an old ulcer, and also from one of Helmholz’s cases in which recovery followed after an attack with fairly typical symptoms. The probabilities are that such a termination is a very infrequent one. The fatal outcome is due quite as much to the condition of the patients in which most of the ulcers are seen as to the ulcer itself. TREATMENT Regarding treatment, little can be said; medical treatment is to be symptomatic onl^q and surgical treatment is as yet inadvisable in most eases. REPORT or PERSONAL CASES Case 1.—Perforating duodenal ulcer folloiced hy general peritonitis. History.—D. M., a female child, 3 months old, admitted to Babies’ Hospital because of loss of weight, vomiting and constipation. Family history unimpor- tant; ninth child; plump at birth; no breast feeding, and had never thriven. The previous history suggested pyloric stenosis; there had been frequent vomit- ing since the child was 2 weeks old. This occurred after nearly every feeding and was forcible, but the food had been principally milk formulas rather high