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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    attention. After a delay of nearly three years, she sought admission into the hospital, as already stated, on February 19th, 1857, her professed wish being to have the opening closed. 3. Observations on her condition while in hospital.—She has jet-black hair and dark eyes, pale skin, prominent lips, melancholic countenance, and although spare, is not much emaciated. She has kept her bed for nine years; and consequently she is quite unable to walk or even to stand, and even feels faint and weak when she sits up in bed. There is no great stiffness of the joints, however, and the limbs are wonderfully well nourished; so that the chief reasons for her keeping her bed appear to be habit and her own dogged obstinacy. In the epigastric, and upper part of the umbilical region of the abdominal parietes, is an oval opening communicating with the interior of the stomach. The long diameter is transverse, and measures four inches, the vertical diameter being about three inches. When the patient sits up or stands, or, even when reclining, if she coughs, or makes an effort as if to vomit, the walls of the stomach fall out through the opening, the whole organ becoming everted. She can take the stomach out, and push it in again, without feeling the slightest pain, even on free manipulation. Three fingers can be introduced into the cavity of the stomach with ease, and one of them passed down into the pylorus, or upwards into the cardiac orifice. She commonly keeps the opening closed by a gutta percha plug, covered with chamois leather and oil silk, and retained by a circular bandage. When this plug is removed, everything she swallows is almost immediately ejected through the opening, and even when the plug is in situ, some of the liquid portions of the ingesta ooze away by its sides, and, in a slight degree, irritate the surrounding skin. The margins of the opening, for some inches, are red, smooth, glistening, and tender. The mucous membrane of the stomach is of a bright vermilion-red colour, and occasionally bleeds a little, at isolated spots, when irritated. Although handling of the mucous mem-