. Archives of physical medicine and rehabilitation . tal duodenum is de-formed it cannot be distinguished ordi-narily by the roentgen ray from ihe ir-regular outline produced by the valvu-lae conniventes. Unless stenosis resultswith its characteristic signs the roentgenray will seldom discover the of CasesTo throw some light on the relativeimportance of each of these manysources of error I have canvassed ourrecords for the twelve months endingJune 30, 1921. During this periodfive hundred and twenty-two cases inwhich a diagnosis of duodenal ulcerhad been made by the roentgen ray,w
. Archives of physical medicine and rehabilitation . tal duodenum is de-formed it cannot be distinguished ordi-narily by the roentgen ray from ihe ir-regular outline produced by the valvu-lae conniventes. Unless stenosis resultswith its characteristic signs the roentgenray will seldom discover the of CasesTo throw some light on the relativeimportance of each of these manysources of error I have canvassed ourrecords for the twelve months endingJune 30, 1921. During this periodfive hundred and twenty-two cases inwhich a diagnosis of duodenal ulcerhad been made by the roentgen ray,went to operation. In four hundredand ninety-nine cases the ulcer wasfound by the surgeon; in twenty-threecases no ulcer could be the twenty-three cases, eightwere found to have disease of the gall-bladder or appendix, or both. In noneof these was the duodenum organicallyinvolved, and it may be argued that thebulbar deformity op which the roent-genologic diagnosis of ulcer was basedwas the result of spasm from the ex-trinsic Figrnre IV.— (Case A-321623)—Carci-noma of the pyloric tnci of the stom-ach and of the duodenum. Roeutgrendiag-uosis; duodenal ulcer. Adhesions around the duodenumwere responsible for the wrong diag-nosis in seven cases. Five errors were due to prepyloriclesions, cancer in three cases, ulcer intwo. All of these lesions were nearthe pylorus. A cancer involving theliver, but whose origin was not de-termined, may have been the cause ofthe duodenal deformity in one case,and in another the lesion was a cancerof the hepatic flexure. Thus, in twenty-two of the twenty-three cases there was definite justifica-tion for surgical intervention, and intwo-thirds of them the lesion was inthe right upper quadrant of the abdo-men. In the remaining instance noth-ing could be found to explain thesymptoms or diagnosis. During the same period, of five hun-dred and forty-four cases in which anegative roentgen ray diagnosis wasmade, five hundred and t
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