Haemorrhages Occurring during Pregnancy
Authors: A. E. Aust-Lawrence
Journal: BMJ (1890)

the colon in its transverse portion was adherent to the stomach.On further inspection it was found that at a spot rather nearer to the splenic than to the hepatic flexure, at the spot, indeed, where this adhesion existed, there was considerable condensation of tissue, so that the two hollow viscera here were quite inseparable from one another.On laying open their cavities respectively, deep ulceration was found to have taken place at the correspond- ing spot in the interior of the colon, whereby a somewhat funnel- shaped passage had been tunnelled, as it were, through the con- densed tissue, the apex reaching the interior of the stomach, and appearing distinctly on its mucous surface as a somewhat valvular opening of about the size of a goosequill, and situated between two and three inches from the pyloric orifice.The latter was rather contracted, admitting only the point of the index finger, and there was some fibroid thickening of the pyloric ring.There was no ulceration elsewhere in the stomach, but in the depeading parrs of it intense vascular injection with patches of bistre pigmentation.Moreover, there was no ulceration in other parts of the colon, nor any alteration of its lumen or other morbid change.Liquid faecal matter, much coloured with bile, was found here and there in the small intestine.There were no enlarged mesenteric glands, and no secondary deposits on the surface of the liver; but at this stage the examination of the body had to be brought to a close.Sections of the condensed tissue, micro- scopically examined, revealed the presence of a neoplasm, which exhibited the histological characters of cylindrical epithelioma.REMARKS.-The rarity of the lesion present in the foregoing case is amply attested by the scant notice of it to be found in the ordinary textbooks of medicine; in some of which, indeed, there is no notice of it at all.More than thirty years ago the late Dr.Murchison, after ransacking English, American, and Continental medical journals, and all anatomical museums within reach, suc- ceeded in collecting thirty-three cases of gastro-colic fistula.In. searching medical records since, an isolated case is to be met with now and then.Two or three cases may be found in the Pathological Transactions (and only two or three in the now forty volumes).Albeit, Murchison's Memoir, based upon his collection.and published in the Edinburgh Medical Journal, Jilly and August, 1857, must be recognised as still the best source of infor- mation on the subject.Finding, then, as we do on reference to the same, that of these thirty-three cases, the great majority, namely, twenty-eight, arose from disease commencing in the stomach, and only two from disease commencing in the colon; only one, indeed, from cancer- ous disease of the colon; we see that in the case before us we have not merely a rare lesion, but a rare form of that lesion.The prominent clinical feature of the case was the feecal vomit- ing.The overwhelming frequency with which this symptom is dependent upon intestinal obstruction raises a very strong pre- sumption in any given case that this condition is present as the cause of it.Once satisfied, however, to the contrary, the diagnosis in the main is arrived at.Fistulous communication between the colon and the upper part of the small intestine is so surpassingly rare that it can hardly be taken into account; while if diffuse peritonitis ever gives rise to fecal vomiting, as maintained by some writers, intestinal obstruction, as shown by Mr. Treves, must be the proximate cause of it.But, the existence of gastro-colic fistula assumed, it was not so apparent where and what was the disease which had led up to it.