The greater mobility of the large bowel, however, permits of freer move ment on the part of the tumor, with greater displacement and greater vari ability in situation. The closer the growth to the rectum, the more pro nounced the change in the conformation of the stools, which may become charac teristically narrow in caliber or band shaped or ribbon-shaped.
Case of a man on whom the author had operated in 1S94,resecting six inches of the transverse colon, which was the seat of stenosing adenocarcinoma, which had been present for at least a year. The stenosis bad become so great that only a small-sized lead-pencil could be passed through the stricture at the time the specimen was removed. There was great emaciation and pain. Anastomo sis was made with a Murphy button of enormous size, which was passed on the eighteenth day. The man gained thirty pounds in weight in a short time, and has remained in perfect health since. There are no signs of recurrence. A number of nodules in the mesentery had been removed, but there were innumer able small ones which had to be left. Howard Lilienthal (Annals of Snrg., May, *96).
Sarcoma of the intestine is more com mon than text-books indicate. it much more frequently affects the small than the large intestine. The ileum seems to be its favorite location. Sarcoma rarely produces stenosis. Dilatation is more frequent. Usually it grows from one side of the bowel entirely. The diagno sis is difficult and will always remain obscure: still if a smooth, freely mov able tumor be found in the abdomen. unless it can be otherwise satisfactorily accounted for, one should be reminded of the probability of sarcoma of the in testine—especially if there is also pres ent the general picture of sarcoma, with its peculiar anemia. C. Van Zwalen burg (Jour. Amer. Med. Assoc.. Mar. 9. 1901).
Under favorable conditions it may be possible to recognize malignant disease of the sigmoid flexure by means of manual exploration through the rectum or with the aid of the sigmoidoscope.
Diagnosis.—Carcinoma of the duo denum is to be differentiated from car cinoma and ulcer of the stomach, from duodenal ulcer, from gall-stones, and from new growths or enlarged glands compressing the duodenum from with out. From the two forms of ulceration
named, it differs in the progressiveness of character, the shorter period of dura tion, the development of cachexia, the greater wasting, the presence of a tumor, a diminution in hydrochloric acid of the gastric juice, or perhaps its absence, and the smaller frequency of limmaternesis (the blood presenting the characteristic coffee-grounds appearance). The differ entiation from malignant disease of the stomach will have to be based upon the situation of the palpable tumor and its degree of mobility, the frequency and the time of vomiting, and the situation and the time of occurrence of the pain. Gall-stones may occasion symptoms closely resembling those of malignant disease of the duodenum, but they are unattended with cachexia, they differ in course and duration, and the tumor to which they give rise differs in its general physical characteristics from that due to malignant disease of the duodenum. The differentiation from new growths or enlarged glands compressing the duode num from without depend largely upon the recognition of the conditions to which such processes are usually second ary. Such growths and glands are un attended with the pain, digestive de rangement and vomiting so common with malignant disease of the duodenum.
Malignant disease of the large intes tine is to be distinguished from fmcal accumulation, peritonitic adhesions, and the presence of foreign bodies in the in testine. All of these are unattended with cachexia and wasting. In cases of Beal accumulation there is a history of long standing constipation, with the correc tion of which any tumor that was pres ent disappears. When peritonitic ad hesions are present inquiry may elicit the previous existence of peritonitis. Among foreign bodies occasionally found in the bowel are gall-stones, enteroliths, and possibly detached pedunculated polypoid growths.
Enterolith weighing three hundred and seventy-five grains; length, two and one-fourth inches; circumference, one and one-fourth inches; diameter, one inch, removed from ileum by longitudinal in cision. Death occurred the following day of pulmonary oedema. Perry (Albany Med. Annals, June 20, 'SS).