CANCER OF THE PERITONEUM.—Symp tonis.—In primary cancer the symptoms during the early part of the disease may be entirely latent or may consist of an uncomfortable feeling and some pain in the abdomen. As the peritoneum be comes more involved, ascites, emaciation, loss of strength, and the characteristic cachexia appear.
These same symptoms are present in secondary cancer, but are more readily recognized as cancerous on account of the disturbances caused by the primary disease.
In both forms the large effusion may result in difficulty in respiration, and rupture of the vessels in the cancer may be followed by severe with its accompanying symptoms. On ac count of the amount of the ascitic fluid, tumor-masses are not easily palpated until after paracentesis.
Diagnosis. — In the primary form, especially when a large quantity of ascitic fluid is present, it is sometimes almost impossible to establish a diagnosis from tubercular peritonitis with effusion. In secondary cancer the history of malig nant disease in one of the organs makes the diagnosis easy. After tapping, or when tumors can be palpated without resorting to this operation, differential diagnosis must be made between this dis ease and chronic tuberculous and pro liferative peritonitis.
In all three diseases the omental tumor is likely to be present, but in cancer en largement of the inguinal glands is often noted; nodular tuberculous peritonitis occurs usually in children, concerning whom a tuberculous history is often obtainable. Cases of proliferative peri tonitis generally give a history of chronic alcoholism.
Echinococcic cysts may be distin guished by the fremitus, the history, the lack of cancerous cachexia, and exami nation of the fluid. In colloid cancer, although the abdomen may be greatly enlarged, the mass does not fluctuate.
Retroperitoncal tumors are often very difficult to differentiate, but they are generally immovable, while cancerous tumors of the mesentery or omentum are movable and follow the respiratory move ments.
Etiology.—Cancer of the peritoneum is usually secondary to cancer of the stomach, liver, uterus, or some other organ. It is more common in women than in men, and is a disease of middle and late life.
Prognosis.—Cancer of the peritoneum always results in death in from a few weeks to several months.
Treatment.—This is only palliative. Pain may be relieved by the opium prep arations, and constipation by mild laxa tives. If the effusion is so large as to cause distressing symptoms, paracentesis is to be resorted to, care being taken not to enter an adherent intestine.
SARCOMA.—Sarcoma of the mesentery is of rapid growth and almost always results fatally. Ascites is usually pres ent in these cases. These growths are seldom removed successfully by opera tion, because they are attacked too late. There is rapid involvement of surround ing structures, making complete removal impossible. A fatal termination is in evitable.
Fifty-seven cases of solid mesenteric tumors collected from literature, of which 10 were sarcomas, and the follow ing personal case occurring in a physi cian, whose illness was of about three months' duration.
Before death diagnosis of cirrhosis of the liver had been made, based on the presence of a large amount of free fluid in the abdomen and inability to palpate the liver or outline it on percussion. Necropsy showed a tumor involving the mesentery and mesenteric glands, with metastases in the head of the pancreas, the greater and lesser omentum, the lymphatic glands at the neck of the gall bladder, the pleura, and the bronchial and inguinal glands. There was also compression-atelectasis of the lower lobe of the right lung, chronic passive con gestion of the spleen, cirrhosis of the liver, and general anasarca. On micro scopical examination diagnosis of lym phosarcoma of the mesentery was made. Maximilian Herzog (Jour. Amer. Med. Assoc., Feb. 11, '99).
HYDATIll CYSTS of the peritoneum are found in the mesentery, the omentum, and broad ligaments, and are secondary to primary growths of visceral organs: the liver, the spleen, and the kidneys. They cause great pain by traction. The diagnosis is made by a peculiar fremitus; but this sign cannot always be obtained, so that the true condition is seldom learned until after exploratory incision. The only treatment is cceliotomy. All cysts should be removed when possible or else incised and evacuated, followed by thorough washing and drainage. These cases are often successfully dealt with by operation, the only dangers being those common to the average cceliotomy.