Acute Jejunal Obstruction in a Case of Advanced Pregnancy: Operation: Recovery

Abstract

gastreotomy from a woman of 32, in whom carcinoma developed after thirteen years' medical treatment for gastric nlcer.5The death-rate of this operation should not be more than 15 per cent. In the 17 that I have done 3 have died -one in whom also I removed a portion ox liver to which the pyloric end of the stomach was adherent died two months later as the result of a biliary fistala; one died from shock; and in the other the wound had to be hurriedly sutured with one layer of stitches; on the fourth day these gave way and he died from bronchopneumonia developed after the second anaesthetic.The results of this operation are encouraging. The average duration of life, if recarrence takes place, is eighteen months. This is a considerable gain, as the duration of life from the first onset of symptoms in untreated cases is rarely more than twelve months. The quality of life is good; as a rale, no indigestion or vomiting, and the recurrence usually does not affect the stomach. At the present time about 65 per cent. of those who have survived the operation died ot recurrences within three years. We must, however, remember that these were all "' late " cases. When seen on October 25th she complained of extreme pain in the lower abdomen. On examination there were no signs of commencing labour, and the bowels had acted on the previous day. There had been a similar attack two days before, which had lasted-two or three hours. On October 26th the pain shifted from the pelvis and became epigastric and severe, and the vomiting, which had comnnenced on October 25th, now became continuous.Notwithstanding all forms of treatment these symptoms continued until October 28th, when she was seen by Dr. R. A. Gibbons and Dr. Herman, and the opinion was formed that the patient had intestinal obstruction high up in the small intestine. It was thought that induction of labour was not justified, and laparotomy was advised. Later Mr. Warrington flaward saw the patient and concurred with this view.The patient was removed to a nursing home that night late, and was operated on at 4 am. on October 29th, Dr. Gibbons and Mr. Haward being present.Notes by Mr. Wallis. The patient was carried straight on to the operation table, where I first-saw her. She was much distressed and in a nervous and excited condition. She was violently sick when on the operation table. After this had passed off she was anaesthetized by Mr. Bellamy Gardner and the abdomen was painted over with iodine solution. The abdomen was opened by an incision in the mid-line above the umbilicus 5 in. in length. The uterus presented itself at the opening and was gently held forwards. The stomach was found to be much distended, as was also the duodenum. The small intestine was collapsed and Empty.The uterus was held still further forward to enable the commencement of the jejunum to be seen, and it was at once obvious where the obstruction lay. About 6 in. from the commencement of the jejunum the gut was seen to be pressed on by the uterus-there was no suggestion of volvulas, but there was...