FOUR CASES of GASTRO-ENTEROSTOMY for PYLORIC CANCER
Authors: A. E. Barker
Journal: BMJ (1898)

WE are so much in need in this country of completed series of the various operations on the stomach to enable us to judge of the proper cases in which to perform them, and to estimate their risks-that I venture to give a brief account of my last four cases of gastro-enterostomy, which, with two previously recorded, complete my experience of this operation.The records of the cases before me are very full and complete, but I trust I shall not omit anything essential in the abstract which follows:CASE iii.-A lady, aged 43, extremely emaciated and anaemic when I first saw her on October 28th, i892.Her medical attendant, Dr. Preston, of Canterbury, had already, after a very careful examination of her symptoms, and an analysis of the vomited matters, and the discovery of a tumour of the pylorus, come to the conclusion that she was'sufering from carcinoma ventriculi, with distinct symptoms for at least six months-a view which I had only to confirm.As the lady was suffering great pain and distress from pyloric obstruction and dilatation of the stomach, itwas decided to give her relief if possiblebygastro-enterostomy.This operation I performed on October 2gth, 1892.Her room and all sur- roundings had been previously arranged in the most complete manner by Dr. Preston, leaving very little chance of anything being overlooked which could contribute to the success of the procedure.The method adopted was precisely the same as in my first case, published in the BRITISH MEDICAL JOURNAL of I886, where I practised a method of suture original with myself,which has since been frequentlyemployed by others,but not always acknowledged.The operation (anterior gastro-enterostomy) was not specially difficult.and was completed in I hour and 43 minutes.The patient recovered fairly from the operation, but 12 hours later became very weak, and gradually sank from exhaustion, dying just 24 hours after the completion of the operation.There was, I believe, no post-mortem examination.CASE IV.-J.C., aged 39, was admitted into Dr.Ringer's ward at Uni- versity College Hospital on October 17th, I895, complaining of general wasting and loss of appetite.He dated his trouble from the previous August.It began quite gradually with wasting and loss of appetite; vomiting followed, and continued daily for the last month, with constant nausea and burning pain after food.Bowels confined; motions small and very white.There was on admission a small tumour to be felt to the right of and a little below the umbilicus which was slightly tender.There was considerable dilatation of the stomach.Sarcince were discovered in the vomited matters.While in hospital there was very rapid loss of weight.The diagnosis of pyloric growth with stenosis having been made, with very rapid and extreme emaciation, it was felt that the only prospect of relief W2S to be looked for in a gastro-enteros- tomy.This I performed in the usual way, but employing a Murphy's button, on November 4th, I895.There was no difficulty either in deciding as to the course to be pursued or in the operation.The pyloric growthI was far advanced, and there were numerous secondary deposits in the glands.I therefore united the anterior wall of the stomach with the ejunum at the usual spots with the button, and closed the abdomen.Two days later the patien'u died quietly of asthenia.Po8t mortem Examinationt.-Everything in the abdomen was found satis- factory.The button lay well in position, pressing a little on -the colon.CASE V.-E.C., a nurse, aged 47, was transferred to my charge through the kindness of my colleague, Dr. Roberts, under whose care she had been admitted into University College Hospital on October .4th,I897.Her symptoms then were pain in the stomach after meals, constipation, and vomiting.She had had symptoms of indigestion for the past seven years, the constipation alternating of late with diarrhbea, the motions being often of a dark colour.Had never noticed blood in the vomited