Case of communication with the stomach, through the abdominal parieties, produced by ulceration from external pressure : with observations on the cases of gasto-cutaneous fistulæ already recorded / by Charles Murchison.

  • Murchison, Charles, 1830-1879
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: Case of communication with the stomach, through the abdominal parieties, produced by ulceration from external pressure : with observations on the cases of gasto-cutaneous fistulæ already recorded / by Charles Murchison. Source: Wellcome Collection.

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    In 1 case it was 2 inches in diameter (8); In 2 cases it was at first about 1 inch in diameter, but, shortly before death, increased to the size of a half-crown, or a whole crown piece (21, -23); In 1 case it was 4 inches by 3 (25). It will thus be seen that in none of the cases hitherto recorded did the opening at all equal in size that which exists in Catherine Ross (25). E. Escape of Food swallowed by Artificial Opening. In all of the cases this phenomenon was observed. In six cases (7, 11, 17, 18, 19 and 20) fluids only are stated to have escaped, and in these the opening was either very small, or no mention is made of its size. In all the other cases, whatever the patient swallowed immediately escaped from the opening. This escape of food has usually been prevented by some artificial contrivance, such as a plug of linen, gutta percha, &c.; but it has always been found difficult to prevent the fluid ingesta from oozing out by the sides of the plug. In the case of Alexis St. Martin, the necessity for such an artificial plug became, after a time, superseded by a natural one, consisting of a slight protrusion of the coats of the stomach, so that food only escapes on the depression of this. It is probably to this provision of nature for preventing the escape of food, that this indivi¬ duals good health and long life are in no small degree to be attributed. A tendency to the formation of a similar natural plug was also observed in Cases 15 and 21; but in the case of Catherine Ross the opening is so large that the whole stomach becomes everted through it. It is to be remembered, in reference to the diagnosis of such cases, that a fistulous opening in the abdominal walls, from which food escapes immediately on being swallowed, does not necessarily communicate directly with the stomach. We have already seen that in Case 17 the opening was rather on the duodenal side of the pylorus. Again, in the museum of Charing Cross Hospital there is a preparation