MALIGNANT STENOS1S OF THE PYLORUS causing gastric dilatation should be treated in the main upon the above lines. After abdominal section, if the malignant growth is limited in extent, pylorectomy may be found a practicable operation, and the pylorus and the neighbouring region of the stomach should be removed. Where the removal of the diseased mass is difficult, a gastro-cnterostomy may be performed first, and after an interval when the patient has regained sufficient strength the pylorus may he excised. In hopeless cases beyond the reach of a resection prolongation of life may be afforded by a gastro-enterostomy when the pain and vomiting are incessant.
In these cases, a considerable amount of exhaustion being already present, the duration of any operative procedure is often a vital point, and the surgeon may well consider the advisability of performing the anterior operation, in which the stomach opening is made in the front wall of the organ nearer the cardiac than the pyloric end, and the anas tomosis effected with the jejunum about IS inches from its junction with the duodenum.
There is yet another type of gastric dilatation which, however, never reaches to the great dimension of the previous varieties. This is the form in which an open ulcer exists at the pylorus; the irritation caused by the existing hyperchlorhydria causes reflex spasm, and keeps the opening shut. The best procedure in such cases is at once to resort to gastro-enterostomy.
H.ToDENAL I IILATATION.—This is usually due to Glenard's Disease, and will disappear on the removal of the cause; when Lavage and the palliative measures mentioned on p. 307 fail, operative procedures must be undertaken.