Perforating gastric ulcer, posterior gastro-enterostomy, Fowler's position / J.H. Musser and W.W. Keen.

  • Musser, John Herr, 1856-1912.
Date:
1904
Catalogue details

Licence: In copyright

Credit: Perforating gastric ulcer, posterior gastro-enterostomy, Fowler's position / J.H. Musser and W.W. Keen. 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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    cool extremities. She lay on the left side chiefly. The pain was considerable in the back and right shoulder. Liver dullness was present. A perforation had doubt- less taken place, and an operation was advised. Dr. Keen saw the patient at 12 m. Dr. Eeed, her former attendant, joined us. Eeaction had set in. Temperature, 99; pulse, 85. The patient complained of great pain and favored the left lateral dorsal position. Drs. Keen and Eeed concurred in the diagnosis of per- foration, and urged with me immediate operation. Dr. Keen operated at 3 p. m., flve and a half hours after perforation had taken place. SURGICAL HISTORY AND REMARKS BY DR. KEEN. I first saw Mrs. M., a woman a little past 70 years of age, in consultation with Dr. J. H. Musser and Dr. Boardman Eeed, Nov. 26, 1903, at noon. I had known the patient for a number of years. I had not seen her for three or four years and was struck with her loss of weight and emaciation. After an examination, I fully concurred in the diagnosis of perforated gastric ulcer, and three hours later the operation was done. An incision was made to the left of the middle line on account of extensive diastasis of the recti muscles following her single pregnancy about forty-eight years ago. Only a very few muscular flbers were seen. The muscles were not only widely separated, but greatly atrophied. The entire abdominal wall was not over 1 cm. in thickness. As soon as the abdomen was opened, a little turbid, rather dark colored fluid poured out, and when the stomach was dra’wn out, a few flakes of lymph were found on it. In a moment the perfora- tion was discovered. It was an aperture slightly oval, very sharply punched out, 5 mm. in its long diameter, situated precisely in the middle of the pylorus ante- riorly. The whole pylorus was thickened, but not nodulated. Evidently it had been the seat of an old ulcer involving all the anterior wall. The ulcer was immediately closed by a continuous Lembert suture. The abdominal cavity was then flushed out with a large quantity of salt solution, care being taken to wash out between the diaphragm and the liver, and also down into Douglas’ cul-de-sac, where a considerable amount of turbid fluid was found. The diaphragm was but lit- tle injected. The transverse colon was then turned up.