Case of communication with the stomach, through the abdominal parietes, produced by ulceration from external pressure : with observations on the cases of gastro-cutaneous fistulæ already recorded / by Charles Murchison, M.D.

  • Murchison, Charles, 1830-1879.
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: Case of communication with the stomach, through the abdominal parietes, produced by ulceration from external pressure : with observations on the cases of gastro-cutaneous fistulæ already recorded / by Charles Murchison, M.D. Source: Wellcome Collection.

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

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    In four ceses (8, 15, 16, and 22) the opening was situated between some of the left ribs, portions of which, or of their cartilages, had been removed. In Case 16 (St. Mai'tin) this was the result of a gun-shot wound. In 15 and 22, and perhaps also in 8, the ribs appear to have been destroyed in the progress of a simple ulcer of the stomach. In Case 17, which originated in a perforating ulcer on the duodenal margin of the pylorus, the external opening was between the seventh and eight right ribs, below the right mamma. In connexion with this, it is important to allude to a case mentioned by Cruveilhier, in which a simple ulcer, commencing in the stomach, was found to have eroded the posterior surface of the ensiform cartilage.^ 2. The margins of the opening are generally described as rounded, hard, or of cartilaginous consistence, in those cases resulting from either wound or simple idceration. In two cases (11 and 21) the margins are noted as having been depressed or drawn in; and in a third (18) this retraction of the margins was so great, that the opening resembled a funnel. All these three were cases of simple ulcer of the stomach. In cases resulting from cancer, the margins of the opening may be ragged, or even gangrenous. In Catherine Ross they are red, glazed, and firmly cicatrized, and there appears to be a gradual transition between the skin and mucous membrane. 3. The integuments surrounding the opening for some inches are usually red, tender, and more or less excoriated, owing to the irritation from the constant escape of the fluid contents of the stomach. 4. The size of the external opening varies greatly. Thus— In 7 cases it was doubtful (3, 4, 5, 7, 11, 17, 24); In 6 cases it was less than 1 inch (10, 14,18, 19, 20, 22); In 7 cases it was about 1 inch in diameter, or easily admitted finger (1, 2, 6, 9, 12, 13, 16); In 1 case it was li by \\ inch (15.) ' Op. ill., ii, .■566.