. American practice of surgery ; a complete system of the science and art of surgery . their appear- 734 AMERICAN PRACTICE OF SURGERY. ance and their characteristics depend upon the location of the o) is especially true in cases of circular carcinoma of the bowel. The steno-sis may be multiple. If the stenosis is located in the duodenum the symptoms will be compara-tively late in presenting themselves because of the liquid character of the con-tents. The nature of the symptoms will depend upon whether the stenosisis located above or below the opening of the common duct. If it i
. American practice of surgery ; a complete system of the science and art of surgery . their appear- 734 AMERICAN PRACTICE OF SURGERY. ance and their characteristics depend upon the location of the o) is especially true in cases of circular carcinoma of the bowel. The steno-sis may be multiple. If the stenosis is located in the duodenum the symptoms will be compara-tively late in presenting themselves because of the liquid character of the con-tents. The nature of the symptoms will depend upon whether the stenosisis located above or below the opening of the common duct. If it is locatedabove, they will be practically the same as those in pyloric stenosis; if below,the presence of bile and pancreatic juice in the vomited matter may be of sig-nificance; but unless the stricture is very marked, this point is of little practicalvalue. When the stenosis is situated at the papilla, the symptoms may veryclosely simulate those of cholelithiasis or of carcinoma of the head of the pan-creas. If the stenosis is located in the upper portion of the jejuno-ileum, the. Fig. 283.—Sutures of Different Kinds. (Original.) A, Lembertsuture; Czerny-Lembert suture. B, Czerny suture; C, symptoms may closely resemble those of gastric disorder. They are never ofa well-defined character. Those most commonly noted are indigestion, eruc-tation of gas, bad breath, anorexia, coated tongue, sometimes constipation,vomiting, meteorism, colic, and visible peristalsis. The most important symp-toms, in their bearing upon the diagnosis, are the attacks of colic and the in-creased peristalsis. These attacks do not present themselves until the stenosisis considerably advanced. They may last but a few minutes, or they maycontinue for a number of days, occasionally culminating in an acute obstruc-tion. The attack of pain is usually accompanied by vomiting. The pain inthe abdomen may be localized over the stenosis; it may also be general, or itmay be located at a remote point. In the earli
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