Preliminary report on the diagnosis of postpyloric (duodenal) ulcer by means of serial radiography / by Lewis Gregory Cole.

  • Cole, Lewis Gregory, 1874-1954.
Date:
1913
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Licence: In copyright

Credit: Preliminary report on the diagnosis of postpyloric (duodenal) ulcer by means of serial radiography / by Lewis Gregory Cole. 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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    and the various nonpathological conditions which influence its appearance, as observed by serial radiography.1 The differentiation of postpyloric (duodenal) ulcer from prepyloric (gastric) ulcer and carci- noma, and the differential points between ulcer and gallbladder infection have been previously de- scribed.2 Subsequent observations in pursuance of this and other diagnostic points will be communicat- ed within the next month. They will include the physiology of the pylorus as observed radiographi- cally, particularly the absence of a periodical re- laxation and contraction of the pylorus, independent of peristalsis, the reservoir function of the cap (pil- leus ventriculi), and the periodical propulsive peri- stalsis of the descending and horizontal duodenum. A careful study of the pathology of chronic duo- denal ulcer, as described by Moynihan or Codman, is essential to its radiographic diagnosis. Of the pathological findings which they report, the fol- lowing are especially important radiographically: 1. Ninety-five per cent, of duodenal ulcers occur in the first or ascending portion of the duodenum (cap). 2. The crater of the ulcer is usually about one centimetre in diameter, and surrounded bv an area of induration, similar to a furuncle. 3. There are usually cicatricial contractions, re- sulting in a formidable narrowing of the lumen of the gut. 4. Healed ulcers result in a restoration of the mucosa, but a destruction of the muscular coat, which is replaced by connective tissue. The serous coat may or may not show evidence of adhesions. It is obvious, from a comparative study of the normal cap and the pathological findings of duo- denal ulcer, that induration and cicatricial contrac- tion could not exist, without distorting the sym- metry of the lumen of the cap. By means of serial 1Archives of the Kontgen Kay, April, 1912. ‘Archives of the Kontgen Kay, October, 1912.