Gastrostomy : establishment of a gastric fistula, in a case of stricture of the oesophagus / by George Buchanan.

  • Buchanan, George, 1827-1905.
Date:
[1881]
Catalogue details

Licence: Public Domain Mark

Credit: Gastrostomy : establishment of a gastric fistula, in a case of stricture of the oesophagus / by George Buchanan. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    GASTROSTOMY ; ESTABLISHMENT OF A GASTRIC FISTULA, IN A CASE OF STRICTURE OF THE (ESOPHAGUS. \ By GEORGE BUCHANAN, ■} ^ROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF GLASGOW. ('From notes bit J. L. Steven, M.B., and J. K. X.ove, M.B., House- Surgeons in the Glasgow Western Infirmary.) The following case is worthy of record; for although the patient died in a fortnight of inanition, the operation itself was performed with suecees, the patient recovered from the effects of it, the wound healed, and a perfect gastric fistula was established. The stomach, from long disuse, seemed to have lost much of its digestive and absorbent powers, so that the fluid nourishment which was introduced and retained failed to strengthen the patient. Whether an earlier resort to the operation might have enabled the man to live longer is diffi- cult to say. But the case is another illustration of the fact that an opening can be made with safety into the stomach through the abomiual walls. Win. B , aged sixty, a porter, was admitted into Ward III. of the Western lulirmary on Sept. 10th, 18S0, com- plaining of symptoms pointing to obstruction of the oeso- phagus. His family and personal history, apart from the present illness, are remarkably good. The symptoms above alluded to began in the month of February, 1880, with difficulty in the swallowing of solid food. Gradu- ally this difficulty increased till, in the month of June, he was unable to swallow such substances as oatmeal porridge. For some time after this his diet consisted chiefly of porridge made with pea-meal. Soon, however, nothing but liquids could pass, and his diet was chiefly milk and beef-tea. On admission not even fluids could be swallowed, any attempt in that direction being followed by their regurgitation in a few minutes, or sometimes less, in a frothy condition. During all these months he had been getting steadily thinner, and on admission was very considerably emaciated. At no time was pain or dyspnoea a feature of the case; indeed, apart from the inability to swallow, he made no complaint but of weakness. Dr. Buchanan failed to pass a probang and oesophageal bougie, both of which stuck about half-way down the oesophagus. No exact weight of patient was taken on admission, but it was evident that, notwithstanding the continued use of nutrient enemata, he was rapidly emaciating. These enemata were commenced on Sept. 20th. His weight on Oct. 16th was 7 st. 5 lb.; on Oct. 18tb, 7 st. 2j lb. The emaciation continuing, Dr. Buchanan decided to operate, and on Oct. 27th gastrostomy was performed. The operation.—An incision one and a half inches in length was made across the linea semilunaris, about an inch below and parallel to the eighth left costal cartilage. The tissues were divided down to the peritoneum and the cavity of the qbdomen opened. The transverse colon was now ex- posed to view at the lower part of the wound. On the intro- duction of a pair of forceps in search of the stomach, the anterior wall of that' organ was seen on withdrawing the instrument to have been grasped, and the gastro-epipioica artery on the greater curvature, two inches below the part, was seen to be held up. Through the part of the stomach wall thus brought to the opening two acupressure needles were thrust at a distance of one and a half inches apart, and, having been passed through the organ, were again thrust through the wall, and the ends made to rest on opposite sides of the wound, the stomach was now carefully stitched by ten carbqljsed silk sutures to the edges of the wound, and an incision about an inch in length made through the wall of