The usual seat in the duodenum is the superior horizontal portion not far from the pylorus. There may be a single ulcer or several. The lesion may assume all grades of severity, from a simple erosion to deep loss of substance. There may be, besides, diffuse inflammation of the mu cous membrane. The process is a rapid one and it may quickly cause death; al though, on the other hand, the symptoms may be deferred for some time.
Ulceration of the duodenum may occur also from other causes, such as em bolism, thrombosis, as in the course of endocarditis, atheroma, pulmonary ab scess, amyloid disease, catarrhal or fol licular disease, or tuberculosis.
Prognosis.—The prognosis, while per haps a little uncertain, is, on the whole, favorable, providing the disease is recog nized and intelligently treated. There is, of course, the danger of fatal haemor rhage as well as of perforation and peri tonitis, while recurrence is not rare, and carcinoma may develop at the site of pre vious ulceration. The affection is some times exceedingly unyielding to treat ment, and its duration may be pro tracted.
Within the past eight years the mor tality (when operation has been per formed within twelve hours) has fallen from 39 to 17 per cent. in the treatment of gastric ulcer, and a similar improve ment will take place in the recognition and proper treatment of duodenal ulcers. Operation is seldom called for before per foration has occurred. R. F. Weir (Med. Record, May 5, 1900).
Treatment.—The treatment does not differ essentially from that laid down for gastric ulcer, and includes rest in bed; a bland, unirritating, nutritious diet, in cluding especially predigested milk; and the administration of alkalies, prepara tions of bismuth, and iron. Hwmor rhage will demand absolute rest, absti nence from food by the mouth, and the administration of opium and perhaps also of ergot. The local aplication of an ice-bag may prove serviceable. A single copious haemorrhage or repeated free bleeding may justify surgical interven tion and cauterization or ligature of the bleeding point. There is justification, further, for excision of the ulcer to re move the possibility of the subsequent development of carcinoma.
Case of perforated duodenal ulcer cured by operation. A. Landerer and Glueeksmann (Mit. aus den Grenzge bieten det. Med. u. Chic., B. I, II. 2).
In duodenal ulcer absolutely nothing be given by the mouth for about a fortnight. As a nutrient enema, beef broth. 140 grammes; 0 eggs ; wine, 20
grammes; sodium chloride, 2 small tea spoonfuls, beaten up for some time and injected lukewarm is excellent. The amount ought not to exceed 250 cubic centimetres. The nutrient ought to be varied with ordinary evacuants. After a fortnight's time a gradual return to ordinary alimentation is recommended. Surgical intervention has been followed by good results. Latlevi.ze (.Torn. de 11(41. et de Chic. Prat., Mar. 25, 1901).
The medical treatment of duodenal ulcer should be carried out with the same persistence and came as are needed in treating ulcers of the stomach. Sur gical treatment may be called for: (1) when an acute ulcer perforates, (2) when subacute or chronic perforation leads to periduodenal or subphrenic abscesses, (3) in chronic ulcer when pain and gastrorrhagia or enterorrhagia are persistent and disabling, and (4) when vieatricial contraction and induration or periduodenitis have caused narrowing of the calibre of the gut and dilatation of the stomach or of the stomach and that part of the duodenum behind the stric ture. B. G. A. Moynihan (Lancet, Dec. 14. 19011.
Cxcum, Diseases of.
Synonyms. — Typhlitis; cmcitis; in flammation of the crecum; paratyphlitis; perityphlitis.
Symptoms. — The most distinctive symptom of typhlitis is pain or a sense of discomfort in the right iliac region. With this there is, as a rule, associated constipation, although there may be diarrhcea. The appetite is likely to be impaired, the tongue to be coated, the breath to be offensive, a bad taste to be present, and there may be tympanites, as well as nausea and vomiting. The tem perature is but little affected and the constitutional disturbance is inconsider able. The presence of fmcal masses in the bowel may give rise to a palpable tumor, yielding dullness on percussion. Extension of the disease-process to the appendix will induce additional symp toms elsewhere described as characteris tic of this condition. Inflammation of the connective tissue or of the peri toneum surrounding the ciecum will be attended, in addition to febrile manifes tations and a general aggravation of existing symptoms, with a sense of doughy induration on palpation, on the one hand, perhaps progressing to suppu ration, with the possibility of rupture into the peritoneal cavity; and, on the other, with the development of signs of peritonitis, which may remain localized or become diffuse.