The symptoms, treatment and sequelae of non-malignant duodenal ulcer / par D'Arcy Power.

  • Power, D'Arcy, 1855-1941.
Date:
[1906]
Catalogue details

Licence: In copyright

Credit: The symptoms, treatment and sequelae of non-malignant duodenal ulcer / par D'Arcy Power. 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.

    9/18 (page 9)
    Tlie patient is a pale man with a temperature'of 97' F.: pulse 92, soft: ami respirations 28. llis alnlomen moves evenly during respiration and there is a point of maximum tenderness in each iliac fossa There is also a ten.hr sp.tt one inch to the right of the nml)ilicws, hut this point varie.s som.'wliat in position. So h)iig as the patient was in the hospital he had neither pain, vomiting nor nuhena: but in view of his history, of the large quantity of hloo 1 he h:id brought np and the situation of the pain 1 had no diflicnlty in making a diagnosis of duo- denal ulcer. 1 performed a posterior gastro jejunostomy upon liim, with tlie concur- rence of Dr. Herringham, on 19th May. The patient made an absolu ely unevent- ful recovery: the wound was healed and the stitches were removed on May 28th. and when he was discharged to the Convalescent Home’at Swanley on .Iiine 17th. he' had snlTered neither indigestion, stomach ache or pain since the day after the operation. The attacks of pain and vomiting recommenced about live weeks after the- patient left the hospital and a fortnight after he laid been at home ami had retur- ned to his ordinary diet. \Vhen he repor ed himself tO' me four months later, they were often as severe as they used to be before th.e operation. The attacks bear no relation to the taking of food which he says he limits to fish, stew-s milk and a very little meat, though his wife aftirms that «he denies himself nothing ■ and she is sure he is the worse tor it. The patient was readmitted to the Hospital on January (ith. 1905 on account of sickness ami [)ain after food. Ho vomited from time to lime, vomit containing ch)ts of blood, but the patient said that he did not feel ill in himself. Ho was pla- ceil on low diet, no solids, and was given a little essence. On January 10th. he suddenly became collapsed in the ni.)rning as he was lying in bed. He felt faint and became very cold. A few minutes later he vomited a little dark blood. His bo- wels were open involuntarily whilst he was collapsed and the motion seemed to contain a little blood. At .S..30 on tin; same day he vomited twenty ounces of dark coloured blood. At -1 a. m. on January 12lli. he again became collapsed without any warnitig and at 8- 30. a. m. on the same day he vomited twenty-five ounces of blood in clots, but he had no melmna on this or any subset[netit day. He was col- lajised for a third lime on January 2-lth. the attack being quite sudden and his pul- se becoming imperceptible, but he liad neithin' luematemesis or mehena afterwards and was without further bad symptoms during the remainder of his stay in the Hospital. He was discharged on .March 8th. 1905 and has not since been heard of. Diagnosis. The diagnosis of a perforated duodenal idcer should he easy hat in practice it is often a matter of great diffi- culty as is sliown hy the cases I have just (pioted. The patient is suffering acute ahdijrninal pain and Ihe atlack began suddenly. The history of previous good health, the fact that the ahdornen is mo- ving during respiration, Ihe absence of any great amount of rigi- <lity in the abdominal muscles of .of aiiy point of maximum ten- derness, are all misleading ami make it difficult for Ihe surgeon to believe that Ihe patient is suffering from such a dangerous con- tlition as a perforated ulcer of the duodenum. He may think of a peiforating or leaking gastric ulcer, hut the symptoms are much