GASTRIC DILATATION AND PYLORIC OBSTRUCTION.
When caused by temporary or periodical blockage or kinking of the duodenum owing to Glenard's Disease, or more especially to ptosis of the right kidney, rest in bed is essential till the symptoms of dilatation or distension pass off. If the cause of the primary enteroptosis is of recent origin, as after prolonged strain or rapid emaciation, the rest in bed if sufficiently prolonged may cure the primary as well as the secondary condition. The general treatment is to be conducted upon the same lines as in atonic dilatation, small liquid or semi-solid meals taken at short intervals, and periodic lavage to wash all residue of food from the dilated organ are clearly indicated if relief does not speedily follow rest. Where vomiting every two, three or more days has occurred, abnormally large quantities being brought up at a time, little is to he expected from rest or abdominal supports, corsets or binders, which are useful in mild cases. Assistance may he obtained by the patient altering his position in such a way as to permit the contents of the stomach flowing through the pylorus, and this may even prove useful in the atonic type also.
The patient should be taught to use the tube and wash out the stomach every night if he refuses to submit to a radical operation (gastropexy) for the replacement of the stomach, and suturing it in its normal position by shortening the gastro-hepatic omentum and the gastro-phrenic liga ment. Gastro-enterostomy may be tried, but its results in this condition are often very disappointing, and the same remark applies to the opera tion when performed for simple atony. Even when vomiting is remedied the acquired neurotic condition which has been induced by the viscerortosis may permanently remain, making the victim's life unbearahle. Little can be said for Bircher's gastroplication operation, which consists in making a series of horizontal tucks by passing wide sutures from the smaller to the large curvature with the view of diminish ing the capacity of the organ in its transverse diameter.
Dilatation of the stomach caused by adhesions which drag upon the duodenum from the gall-bladder may he relieved by operative methods suitable to each individual condition. Sometimes success has followed the injection of Fibrolysin, and this has also been advocated in the next type of stenosis.
CicivriricrAL STENUSIS OF THE PYLORUS.-.111 the common form of dilatation of the stomach due to the cicatrisation of old duodenal ulcers, or ulcers at the pyloric end of the stomach, considerable relief may be ohtained by a well-regulated dietary and constant lavagc, especially when the obstruction is many degrees removed from being complete. But even in these latter cases there comes a time when operative inter ference is demanded.
Several operations are available: (i) Loreta's—this consists in making an opening into the stomach in the region of its smaller end, and stretching the fibrous tissue of the stenosed pylorus by inserting a dilator or the finger. (2) Ilahn's operation is simpler; after the stomach wall has been exposed a portion of the anterior surface is invaginated by thrusting the forefinger into the narrowed pyloric portion, and so dilating it without making any incision in the stomach wall. (3) Pyloroplasty: This consists in making a transverse or longitudinal incision through the anterior wall of the stenosed pylorus; the central portion of each lip of the incised wound is next forcibly retracted till the transverse incision is converted into a vertical one, and its lips arc then secured by sutures inserted in the transverse direction or at right angles to its vertical axis. (4) Pylorec loilly: The operation in which the pylorus with the adjacent portion of the stomach is removed. (5) Gastro-duodenostomy: This operation is an extension of pyloroplasty, in which the duodenum is made to communicate with the pyloric: end of the stomach through an opening made in the anterior wall of the latter.