Serial radiography of the stomach and duodenum ... / by Lewis Gregory Cole.

  • Cole, Lewis Gregory, 1874-1954.
Date:
[1912?]
Catalogue details

Licence: In copyright

Credit: Serial radiography of the stomach and duodenum ... / by Lewis Gregory Cole. 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.

    13/37 (page 9)
    Reprinted from “ Archives of the Roentgen Ray,” April, 1912. V \ j Zb* [ /£s*i *■ • -Vff A RADIOGRAPHIC STUDY OF THE PYLORUS AND DUODENUM, WITH AND WITHOUT ARTIFICIAL DILATATION OF THE DUODENUM. By Lewis Gregory Cole, M.D., Radiologist to Cornell University Medical College. In this article, which is the second of a series on the radiographic diagnosis of% gastric and duodenal lesions, I shall attempt to show variations in the duodenum, pylorus, and pyloric sphincter, where there is no radiological evidence of organic disease. The first article in this series described different types of unobstructed gastric peristalsis, and the systole and diastole of the stomach, and it will be difficult to understand the motor phenomena of the pylorus and duodenum without understanding the motor phenomena of the remaining portion of the stomach previously described. The peristaltic waves of the small intestine are so rapid and small that it is difficult to study them either fluoroscopically or radiographically. We can, however, radiographically distinguish the ileum by the coagulated appear- ance of the bismuth contents, and the jejunum by the flocculent appearance (Plate CCCLXXXIV., Fig. 1). This appearance is constant in normal cases, but may be modified in pathological conditions and in cases of intestinal motor inefficiency. The second and third p rtions of the duodenum are usually readily identified by their shape and position (Figs. 2 and 3), unless the intestinal peristalsis is so active as to have a tendency to suck the food away from the pyloric sphincter more rapidly than it is allowed to pass through. In such cases I have pursued a method of artificial dilatation of the duodenum, which will be described later on. The first portion of the duodenum deserves special attention. Anatomically and physiologically it has always been considered a part of the small intestine. Since writing this paper I have learned that Mayo has suggested, both on account of its embryology and its acidity, that the first portion of the duodenum should be considered a part of the stomach. Radiographically it should undoubtedly be considered as a part of the stomach. It is dilated into a cap which surmounts the pylorus, and corresponds in size and shape with the pyloric end of the stomach. It has absolutely no resemblance to the small intestine. Its motor phenomena correspond with the gastric cycle, and have no resemblance to the small, rapid, peristaltic contractions of the remaining portions of the duodenum. The acidity of the contents of this duodenal cap may account for prevalence of ulcers, over 90 per cent, occurring in this