Unexplained perforation of the esophagus in a girl ten years old / by George I. Miller.

  • Miller, George I.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Unexplained perforation of the esophagus in a girl ten years old / by George I. Miller. 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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    Five cm. above the cardia there is seen along the left edge of the esophagus a narrow slit 1 c. long with edges perfectly smooth; the edges are not surrounded by any hyperemic or ulcerative changes either externally or internally. On entering the left pleural cavity there is noted the presence of about 500 cc. dark green fluid. Pressure upon the stomach which was considerably distended with fluid produced a gush of a similar fluid through the slit-like opening into the pleural ca\aty. The fluid in the cavity and in the stomach showed food debris, mucus all bile tinged. Careful examination of all con- tents failed to reveal any foreign body. Examination of the intestine showed at the ilio-cecal valve and scattered over the cecal mucous membrane a few deep red, swollen patches corresponding to swollen Peyer’s lymph nodes; appendix normal. No foreign body found anywhere along the intestinal tract. The lungs showed congestion of both bases. Section of tissue forming the' margin of the slit in the eso- phagus showed histologically only a moderate congestion but no ulceration or necrosis. Sections of the swollen Peyer’s patches show a pronounced hyperplasia of lymphoid tissue with edema and congestion, evidence of an acute irritative process. The fluid in the left chest was noticed before any incision whatever was made after the removal of the sternum. No other lesions were noticed. Rupture of the esophagus has been observed to occur spon- taneously or without apparent cause in rare cases. The majority of these were males and alcoholics. The accident occurred suddenly as a rule after a hearty meal, usually after vomiting or violent concussion of the body. The laceration invohdng all coats is always found close above the cardia and is usually longitudinal. The opening extends into the posterior mediastinum and at the same time into one or both pleural cavities, allowing the contents of the stomach to enter the latter. Weeney recently collected 17 authentic cases of rupture of the apparently healthy esophagus. Zenker and Ziemm.sen, have pointed out that this is probably due to esophagomalacia of the lower portion of the esophagus, caused by autodigestion occurring during life as a result of some peculiar