Operations for non-malignant disease of the stomach : report on 334 cases ... / by B.G.A. Moynihan.

  • Moynihan, Berkeley Moynihan, Baron, 1865-1936.
Date:
1907
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Licence: In copyright

Credit: Operations for non-malignant disease of the stomach : report on 334 cases ... / by B.G.A. Moynihan. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    Reprint from SURGERY, GYNECOLOGY AND OBSTETRICS June, 1907, pages 677-684 OPERATIONS FOR NON-MALIGNANT DISEASE OF THE STOMACH» Report on 334 Cases of Operation for Non-malignant Disease of the Stomach By B G. a. MOYNIHAN, F. R. C. S., Leeds, England Surgeon Leeds General Infirmary, Lecturer on Clinical Surgery, University of Leeds IN the following report I have analyzed and made brief comment upon all the cases of non-malignant disease of the stomach which I had operated upon up to Septem- ber, 1906. For convenience of description the cases are arranged in four groups: Group i 0. s Opera- Recov- Deaths 0 tions eries I Cases of perforating ulcer. . . . 27 18 9 2 Cases in which recurrent hem- orrhage was the cause of im- mediate operation 33 27 6 3 Miscellaneous cases, given in detail later . . . ^ 248 246 2 4 Hour-glass stomach 26 22 4 Total 334 313 21 Perforating Ulcer of the Stomach or Duodenum The perforation of an ulcer of the stomach is a catastrophe which, in my experience, never comes unannounced. In all patients there has been trouble, of a greater or less degree of sever- ity, from the ulcer. In many of the patients the symptoms have persisted for months, and in some they have been of greater severity in the weeks or days preceding the rupture of the ulcer. When perforation occurs, there is a sudden, agonizing pain, a pain which almost reaches the hmit of human endurance. But there is neither shock nor collapse, as a rule. The pulse at the first is not rapid, and the abdominal muscles may not be rigid. It is as well to insist upon these points; for, now that the surgeon is asked to see these cases almost immediately after the occurrence of the perforation, delay may be con- sidered necessary if the pulse-rate is not quick- ened, and if collapse and rigidity of the abdom- inal muscles are absent. Exquisite tenderness of the skin I have always found. The least stroking of the surface with the finger is re- sented. Tenderness and pain on pressure, though general, are often present in a greater degree at one part than at another. So con- stantly is this the case that a careful examina- tion of the abdomen will almost always permit of an accurate localization of the position of the ulcer which has ruptured. The onset of those symptoms formerly considered as necessary to a diagnosis — collapse, abdominal distention, rapidity and smallness of pulse — should not be allowed to develop. A diagnosis can be made from the history of ulcer, the sudden onset and the continuance of intolerable pain, restriction of thoracic movements, surface ten- derness, and abdominal rigidity, or restriction of the normally free abdominal movements. Early operation is indicated in all cases of perforation. The incision should be made to left or right, according to the position of the ulcer as ascertained by examination. The ulcer should be closed and infolded; excision • Remarks contributed to a special discussion at the Royal Medical and Chirurgical Society, London, November 13, 1906. I 603819 PAMPHLETS