A case of gastrostomy performed for stricture of the œsophagus in a woman, aged sixty-six, who survived the operation eighteen months / by R.J. Pye-Smith.

  • Pye-Smith, R. J.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A case of gastrostomy performed for stricture of the œsophagus in a woman, aged sixty-six, who survived the operation eighteen months / by R.J. Pye-Smith. 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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    in the hypochondriac region. During the night she was fed in a similar manner every three or four hours with a few ounces of milk, brandy, egg, and “ fluid meat,” and she was allowed a little water to sip. She got some sleep after a small dose of laudanum. The temperature remained about normal, and the pulse below 80. During the next two days and nights the feeding was continued about every four hours with quantities gradually increased from two to eight fluid ounces. At the end of this period, the number of feedings by the stomach was reduced to three or four a day, and at the same time the patient was allowed to take milk freely by the mouth, and was able to swallow it better than before the operation, so that she got down a pint or more daily. Nutrient enemata were continued occasionally for nearly a fortnight. Within a week of the operation solid food was administered through the fistula, and very soon the artificial feeding was restricted to solids, sufficient fluid being taken by the mouth. Previous to this there was frequently a regurgitation and overflow of fluid from the fistula during the process of feeding. The solids consisted mostly of boluses made of bread-crumbs mixed with “ fluid meat,” macaroni, moderately boiled, oysters, and small sausages. Many other articles of diet were occasionally given in addition, such as meat cut into fingers, haricot beans boiled, gem biscuits, and Brand’s meat lozenges. These substances were pushed through the fistulous opening (the tracheotomy tube being removed), and packed into the stomach by the little finger. When the meal was thus supplied, the opening was plugged, by means of either a piece of india-rubber tubing, closed by a clip, or an india-rubber nipple-shield. There was some suppuration about the upper and outer parts of the wound, and it was not thoroughly healed for a month after the operation, but there was no sign of peritonitis or traumatic fever. Then began the greatest trouble in connection with the case. The plug was never quite water-tight, and, in spite of careful padding and bandaging, a little gastric juice was constantly oozing from the fistula on to the skin around ; and although the mucous membrane of the stomach kept perfectly sound and healthy, the cuticle of the skin was eroded, no doubt by a process of diges- tion, from the margin of the mucous membrane to an inch or two beyond. Partial relief was afforded by alkaline ointments, especially by one of car- bonate of magnesia with vaseline, and, in spite of considerable discomfort from this source, the patient continued to thrive fairly, so that on July 4, three months after the operation, she weighed precisely the same as she did two days before the operation—viz., 6st. 71bs. She frequently sat in bed, and on two or three occasions was up in the ward for a little while, but most of her time was spent lying in bed reading. About this time, I saw a case in which Mr. Howse had successfully operated with a very small wound through the fibres of the rectus, and seeing the great advantage of this method (which entirely prevented any gastric juice erosion), I persuaded my patient to allow me to attempt the closure of the present fistula and the substitution of a smaller one for it. Accordingly, cm August 2, she was placed under the influence of ether, and the anterior wall of the stomach was fixed, by the following method, to the abdominal parietes half-way between the fistula and the middle line of the abdomen. Six pieces of silver wire, each about a foot long, were attached in the middle of their lengths, and at equal distances apart, to an