Annual report of the Peter Bent Brigham Hospital : 1918.

  • Peter Bent Brigham Hospital.
Date:
1918
Catalogue details

Licence: Public Domain Mark

Credit: Annual report of the Peter Bent Brigham Hospital : 1918. Source: Wellcome Collection.

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    21. Colostomy under Novocaine for Acute Intestinal Obstruction — Carcinoma of the Sigmoid, Perforated; General Peritonitis. 8188. Female, 57 years. Transferred from the Medical Service, to which she had been admitted, complaining of upper abdominal pain and distention of seven to eight days’ duration. A married woman, several children. Gen¬ eral health always good. Present illness characterized by severe abdom¬ inal pain in lower abdomen, followed by abdominal distention, complete constipation, no bowel movements nor passage of gas, marked nausea and vomiting. History of somewhat similar attack about a year ago which cleared under enemata ordered by her physician. Referred to the hospital for question of ascites. On admission patient was in extremely poor condition. Temperature 101°, pulse 120, white count 13,000. Ab¬ domen enormously distended, distention not yielding to enemata. Marked nausea and vomiting of fecal material. Diagnosis of intestinal obstruc¬ tion due to malignancy made and immediate operation advised. Patient operated on under novocaine anesthesia, a few whiffs of ether being re¬ quired to get good relaxation. Small amount of free fluid, purulent, due to perforation of the sigmoid, due to acute intestinal obstruction from carcinoma. Glass-tube colostomy done, giving out a large amount of liquid feces and gas. Drainage of abdomen. Patient placed on the danger list. Patient immediately became drowsy and delirious after the opera¬ tion; vomiting continued in spite of colostomy. Died on the third day. Autopsy: Showed general peritonitis; perforation of rectum due to car¬ cinoma of sigmoid. 22. Closure of Gastrojejunal Stoma for Pernicious Vomiting-Jejunos- tomy. 8016. Male, 52 years. Two and one half years ago at this hospital a chronic indurated gastric ulcer was excised and a posterior gastrojejunostomy done, a chronic duodenal ulcer being also noted; good recovery and marked relief of symptoms. Ten months ago, readmission for acute hematemosis, relieved by rest and diet. Later, annoying vomiting. Well functioning stoma shown by X-ray. Exploratory laparotomy January 18, 1918, with negative findings; condition of stomach, pylorus, and stoma satisfactory except for adhesions, which were separated. Persistent gastric and biliary vomiting, rapid loss of weight and strength. January 31, abdomen re¬ opened with negative findings except for considerable scar thickening of mesocolon in region of stoma, not affecting it but possibly crippling the duodenum proximally. The gastrojejunostomy was freed, each viscus repaired, a Witzel jejunostomy done twelve inches distally to insure nutri¬ tion. Patient seemingly stood the operation well, and vomiting ceased, but died of exhaustion three days later. Autopsy: None permitted. 23. Exploratory Laparotomy and Enterostomy for Acute Intestinal Obstruction. 8221. Female, 20 years. Operation for acute appendicitis four weeks ago; convalescence not remarkable. Epigastric pain began three days before present admission, with persistent nausea, vomiting, constipation. Diag¬ nosis of intestinal obstruction of unknown origin was made; operation ad-