Gastrostomy in malignant disease of the oesophagus / by T. Whitehead Reid.

  • Reid, T. Whitehead.
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Gastrostomy in malignant disease of the oesophagus / by T. Whitehead Reid. 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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    inches above its cardiac extremity ; the ulceration has commenced at a point opposite the bifurcation of the trachea, and has ex- tended downwards. It has not invaded the stomach. The ulce- ration at its upper part has perforated the walls of the oesophagus, and has exposed a bronchial gland, which appears as a black mark extending transversely across the tube. The stomach ap- pears to be normal; the gastrostomy opening is situated at the lowest point in the greater curvature, midway between the cardiac and pyloric orifices, i.e., about 8J inches from each. “ The skin, with its orifice, and a portion of the costal cartilages adherent by the results of old inflammation to the greater cur- vature of the stomach, are left in situ. The cancer is of the scirrhous type. There were no secondary growths; no glands were infiltrated.” In addition to these notes of the case, the observations of Dr. Church during the patient’s five months’ residence in St. Bar- tholomew’s Hospital are interesting. He says the operation was perfectly successful, as for many weeks she could fairly enjoy life. There was occasional difficulty in feeding her from contraction of the wound, but the insertion of a laminaria tent for a few hours always overcame the difficulty for some weeks. A No. 8 catheter was used for feeding ; at times the passage of this was painful, but until a few days before death there was no tendency for food to run out of the wound. After I saw her, on October 1, 1883, at the hospital, Dr. Church said she began to complain of occasional pain about the epigas- trium, and towards the end of October she began to be much troubled by a very nasty taste in her mouth, and the presence of much frothy ill-smelling expectoration ; she began at the same time rapidly to lose flesh ; the stomach then began to reject the food introduced into it, and she gradually sank and died without much suffering. At the post-mortem it was noticed that the walls of the oeso- phagus at the stricture were about a quarter of an inch thick and that its mucous membrane was gone, and sloughing was going on in the mucous surface; there was no infiltration of neighbouring parts nor glands. The posterior and lower portion of one lung was gangrenous. She really died of septicaemia from the absorption of putri- hige from the cancerous oesophagus, and not from starvation.