. Surgery, its principles and practice . ollecting of the fluid in the right kidney pouch indi-cates what Smith thinks to be an important point in the treatment. Mayo° has published a series of fifty cases of duodenal ulcer. HeVOL. IV—44 690 SURGERY OF THE INTESTINES. states that in his opinion the causation and continuation of duodenalulcers depend upon the irritating secretions of the stomach, and that thesemust be diverted by gastro-enterostomy. Of his group of perforation cases, six were instances of acute perfora-tion. In all but one the perforation was a complication of chronic ulcerwith
. Surgery, its principles and practice . ollecting of the fluid in the right kidney pouch indi-cates what Smith thinks to be an important point in the treatment. Mayo° has published a series of fifty cases of duodenal ulcer. HeVOL. IV—44 690 SURGERY OF THE INTESTINES. states that in his opinion the causation and continuation of duodenalulcers depend upon the irritating secretions of the stomach, and that thesemust be diverted by gastro-enterostomy. Of his group of perforation cases, six were instances of acute perfora-tion. In all but one the perforation was a complication of chronic ulcerwith a history of four to twenty-one years standing. One patient diedfrom inanition from prolonged leakage, although a gastro-enterostomywas done at the same time. One patient died from pneumonia on thetenth day. The other cases recovered. Hemorrhage occurred in one case with death. At the operation theulcer was easily recognized, and was excised, the pylorus at the same timebeing enlarged. Death occurred from pneumonia on the fifth Fig. 379.—Two Intestinal Perforations in Typhoid Fever (Museum of the Pennsylvania Hospital).A third small perforation existed just above the large one. Resection of the bowel wouldhave been the only possible mode of treating the large perforation, as lateral closure would haveproduced great stenosis. Observe the numerous areas of thinning of the wall of the bowel fromulceration (Keen). Gastric complications occurred in twenty-eight cases. One deathoccurred from the prolapse of a long transverse colon over the loop ofjejunum used for gastro-enterostomy. Complications with disease of the gall-bladder and liver were notedeleven times. No deaths occurred from operation. The remaining thirteen cases, in which there were no symptomscalling for operation on the stomach or the gall-bladder, showed no deaths. Perforation in Typhoid Fever.—The frequency with whichperforation occurs in typhoid fever is illustrated by the recentstatistics collected by
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