On Dropping of the Stomach: A Study Based on a Series of 150 Cases

Abstract

With Plates 1-5 Introduction. SINCE Morgagni first drew attention to the subject in his treatise De Sedibue et Caueis Morborum, an increasing number of authors has dealt with the various displacements to which the abdominal viscera are liable. Perhaps the stomach has received more attention from them than any other viscus, probably owing to the greater facility with which its position could be ascertained even before the advent of the Rontgen rays. It is only, however, since the introduction, in 1899, of the radiographic method of examination after an opaque meal that accurate observation has been possible; and not until the past decade has the value of such an examination become widely recognized. On perusing the literature of gastroptosis, the reader, at an early stage of his inquiry, is impressed by the lack of agreement as to what degree of dropping of the stomach is to be regarded as abnormal. It is obvious that until the position of the stomach, as shown by X-ray examination after an opaque meal of constant weight and consistence, has been observed in a long series of apparently healthy persons, it will be impossible to state with certainty that an organ, the great curvature of which reaches a point 2! cm., 5 cm., or even farther below the iliac crest, exhibits an aberration from the normal. For example, Baetjer (1) found that in a series of selected individuals, all athletes, all thin, but in condition and having no symptoms, each showed more or less visceroptosis. Uncertain as the normal position of the stomach may be, we can, nevertheless, broadly assume that, in a series of cases collected for the purpose of analysis, the lower the level reached by the gastric shadow the more probable is it that we are dealing with a pathological condition. I have selected for the present purpose only the more severe cases, namely, those in which the gastric shadow reached a point approximately 10 em. below a line joining the summits of the iliac crests, my study being ultimately based upon [Q.