. The American journal of roentgenology, radium therapy and nuclear medicine . but later, as oftenas twice a week. Between attacks he feltfairly well. An enema brought no the pre\ious six weeks he had lost 20lbs., and felt very w^ak. He had had nonight sweats. Constipation began severalweeks before and was now \ery would not mo\e without an enema. Physical signs of the heart and lungswere normal. The abdomen was distended,but no peristalsis was n isible. No masscould be felt. There was tenderness on theleft side, just above the level of the umbili-cus. The stomach tes
. The American journal of roentgenology, radium therapy and nuclear medicine . but later, as oftenas twice a week. Between attacks he feltfairly well. An enema brought no the pre\ious six weeks he had lost 20lbs., and felt very w^ak. He had had nonight sweats. Constipation began severalweeks before and was now \ery would not mo\e without an enema. Physical signs of the heart and lungswere normal. The abdomen was distended,but no peristalsis was n isible. No masscould be felt. There was tenderness on theleft side, just above the level of the umbili-cus. The stomach test was normal, exceptfor delay in empt\ ing. The stool showed a Carcinoma of the Small Bowel 421 marked reaction For occult bU)od. HisWassermann test was negati\c, and therewas a secondary anemia. The Von Pirquettest was slightly positive. The urineshowed a high indicanuria. tion showed a delinite constriction. Re-versed peristalsis was seen in the dilatedportion proximal to the constriction. Op-eration was advised for a probable tumorof the jejunum. Dr. ChrlstotYerson found. Fic. I. The .v-ray showed normal chest ( stomach was in a transverse position,but was normal in its findings. The duo-denum was dilated. The small bowel nearthe duodenum was fdled, and remained so,giving the appearance of a stomach withair space above a fluid level. (See Fig. i.)The bowel at the point distal to the dilata- an annular growth in the jejunum nearthe ileum. A resection and a lateralanastomosis were carried out. A specimen of the excised tumor wasshown to Dr. Schultz, who reported asfollows: Gross. Resected segment of smallintestine 5 cm. long. At its middle there is 422 Carcinoma of the Small Bowel a rather sharp constriction 2 cm. inexternal diameter. In which the externalsurface for half the circumference isformed by a slightly raised, firm, palearea i cm. wide in the longitudinal axis otthe gut. Above the constriction the gut Is4 cm. In diameter; below it, cm. In theregion of t
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