Report LXXXIX: The Nature of the Malformations of the Rectum and Urogenital Passages
Report LXXXIX: The Nature of the Malformations of the Rectum and Urogenital Passages
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DOI：
10.1136/bmj.2.2294.1630
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发表时间：
1904-12
影响因子：
--
通讯作者：
F. Wood-Jones
中科院分区：
文献类型：
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作者：
F. Wood-Jones
缝合治疗十二指肠溃疡穿孔2例。案件一，-2010年5月23日。男性，41岁，温和。无既往病史。凌晨2点，上腹部突然疼痛。下午2点，当他第一次被看到时，他的脉搏是00；感觉到右侧疼痛；腹部轻微移动，有点僵硬。症状如此模糊，以至于他被认为患有肺炎。午夜12时30分，他的脉搏达到120次，腹部张开。凌晨2点，我第一次看到病人，打开了他的腹部。在幽门上方发现了一个被打出的溃疡，透明的液体不断地从里面涌出。结果。-手术后五个半小时死亡。尸检记录：穿孔闭合不全。案件二，-1971年7月13日男性，47岁，酒鬼。无既往病史。早上9点突然出现非常剧烈的腹痛，但直到晚上8时30分才申请缓解，当时第一次看到他的脉搏是104；腹部在呼吸过程中移动。有普遍的压痛，最明显的是在上腹区。下午0点45分剖腹时，我发现幽门后部有一个圆形且清晰的穿孔。清澈的液体正从里面涌出。结果。-八天后死亡。这位病人感觉很好，直到他死前24小时，他一直在问他什么时候起床。尸检记录：膈下脓肿；穿孔未完全闭合。在插入缝线后，溃疡仍在继续(？癌症)。凯斯·伊利诺伊，-1902年5月18日男性，37岁，温和。在过去的六个月里，他在饭后半小时内一直抱怨胃痛。中午12点的时候，他感到右侧肋骨下突然一阵疼痛。疼得厉害，他打车去了最近的医院。入院时脉搏为120，腹部活动自如。我在下午6点做了手术-胃没有穿孔，但十二指肠有一个小的干净的溃疡，胆汁染色的液体不断从里面涌出。关闭孔道，在右侧腰椎区域做反切开，并通过引流管。结果。-破裂后35小时死亡。尸检记录：穿孔实际上是闭合的，因为它是防水的。CA6E IV，-1902年7月26日男性，26岁，温和。他曾遭受类似疼痛的发作，但没有严重到晚上7点突然发生的程度，他于7月27日凌晨3点50分入院，但我直到这一天IO才见过他。他的脉搏是112。右侧髂骨区疼痛，疼痛饱满且有痛感。腹部，除了压痛部位外，在呼吸过程中都在移动。我以为他患的是急性阑尾炎，但在髂区剖腹时，发现阑尾是正常的。胃完好无损，但在幽门附近的十二指肠前表面发现了一个穿孔。结果-患者于1902年9月12日出院治愈。在过去的一年里，我不止一次见过他。他正在工作，他说(1904年10月20日)他可以做他的工作，但必须注意饮食。
A.-CASEs OF PERFORATING DUODENAL ULCER TREATED BY SUTURE. CASE I.-May 23rd, x9OI. Male, aged 41, temperate. No history of previous illness. Sudden pain in the epigastrium at iI am Applied for relief at 2 pm When he was first seen his pulse was 0oo; pain felt in right side; abdomen moving slightly and somewhat rigid. The symptoms were so ill-defined that he was thought to be suffering from pneumonia. At 12.30 midnight his pulse was 120 and his abdomen dis-tended. I saw the patient for the first time at 2 am and opened his abdomen. A punched-out ulcer was found just beyond the pylorus, from which clear fluid kept welling up. Result.-Death five hours and a half after theoperation. Post-mortem record: Imperfect closure of the perforation. CASE II.-July I3th, I9OI. Male, aged 47, a drunkard. No history of previous illness. Sudden, very severe abdominal pain at 9 am, but did not apply for relief until 8.30 pm When first seen his pulse was 104; the abdomen was moving during respiration. There was general tenderness, most marked in the epigastric region. Abdomen opened at (0.45 pm I found a circular and well-defined perforation at the back-of the pylorus. Clear fluid was welling up through it. Result.-Death eight days later. The patient felt so well until twenty-four hours before his death that he was constantly asking when he {night get up. Post-mortem record: Subdiaphragmatic abscess; incomplete closure of the perforation. The ulceration had continued after the sutures had been inserted (? cancerous). CASE Ill.-May i8th, 1902. Male, aged 37, temperate. Hadcomplained for the last six months of stomach-ache half an hourafter tis meals. He had felt a sudden pain at twelve o'clock mid-day, on the right side beneath his ribs. The pain was so severe that he took a cab to the nearest hospital. On admission the pulse was 120, the abdomen was moving freely and equally. I operated at 6 pm There-was no perforation in the stomach, but a small clean-cut ulcer in the duodenum, from which bile-stained fluid kept pouring out. The aperture was closed, and a counter-incision was made in the right lumbar region, through which a drainage tube was passed. Result.-Death 35 hours after the rupture. Post-mortem record: The perforation was effectively closed, as it was water-tight. CA6E IV.-July 26th, 1902. Male, aged 26, temperate. Had suffered previous attacks of a similar pain, but none so severe asthat which occurred suddenly at 7 pm He was admitted to the hospital at 3.50 am on July 27th, but I did not see him until IO am on this day. His pUlse Was 112. There was pain over the right iliac region, which was full anf tender. The abdomen, except over the tender area, was moving during respiration. I thought he was suffering from an acute inflammation of the appendix, but on opening the abdomen in the iliac Tegion, the appendix was found to be normal. The stomach was intact, but a perforation was discovered on theanterior surface of the duodenum near the pylorus.Result.-The patient leftthe hospital cured on September 12th, 1902. I have seen him on more than one occasion in the last year. He is at work, and says (October 20th, I904) he is able to do his work but has to be careful in his diet.