The American Journal of Surgery, 1905, Vol. 23 (Classic Reprint)

Excerpt from The American Journal of Surgery, 1905, Vol. 23
Synonyms. - Acute gastro-duodenal dilatation; acute gastric insufficiency; acute gastric paresis; gastro-mesenteric ileus, and arterio-mesenteric obstruction of the duodenum.
Preface. - Briefly, the status of our knowledge concerning this lesion is as follows: That the stomach does occasionally become enormously enlarged in the course of a very short time is an accepted fact. That the duodenum to the root of the mesentery sometimes is associated with the stomach in this enlargement, we cannot say always, is likewise an accepted fact. Our conception, however, of the etiology and the manner in which it acts to produce the condition is very vague, although the symptoms, diagnosis and treatment are comparatively well understood - at least, sufficiently well understood to enable us to recognize the presence of the lesion and institute rational treatment.
We know, reasoning from circumstantial relations, that injuries, operations, anesthetics, wasting diseases, acute infections, and excessive over-loadings of the stomach are important factors in the production of the dilatation; but the process from the beginning of the causal action to the completion of the morbidity is enshrouded in a veil of hypotheses and theories. Our problems, therefore, in the study of the disease are etiological and pathological, and for their solution we must look to the data of cases observed, confirming when necessary by experimentation.
Inasmuch as the condition is rare - our literature would lead us to this conclusion - and its origin obscure and varied, definite determinations are not logical in single cases or in small series; thus the report of one case is without merit except that it contributes to the mass of cases reported, from which only are conclusions justifiable. Viewed in this light, it becomes the duty of all observers to record their cases. It is, therefore, purposed to present the history of a patient who developed an acute dilatation of the stomach shortly after receiving a back injury. It is also purposed to suggest certain conclusions relative to the etiology and pathology of this case.
Report of Case. - (Case 1,009 - Accident Records.) - J. N., French; age 51; married; no children; ship carpenter.
History of Accident. - January 9 1906, J. N. slipped from a ladder and fell into the hold of a boat, striking his back against a channel iron. He was promptly removed to St. Vincent's Hospital.
Examination. - The patient was perfectly conscious and rational. His one complaint was of severe pain in the dorsal region of the back and in the right side of the chest. There was no evidence of paralysis, either motor or sensory - the reflexes were normal and the sphincters under control; or in other words, there was no evidence of a cord lesion.
In the dorsal region, however, was a large hematoma, extending from the spine of the eighth cervical vertebra to that of the seventh dorsal and from scapula to scapula. The great swelling and the extreme tenderness accompanying it prevented examination of the underlying spinous processes, which made it impossible to ascertain whether or not there was any deviation in their alignment; but apparently there was not as the man could bend his back front side to side and forward and backward with comparative ease, though not without pain.
At the junction of the fifth rib and the anterior axillary line on the right side was a small area of extreme tenderness and sharp pain. This apparent costal manifestation was affected by neither respiration, nor compression of the chest.
None of the thoracic organs showed evidence of injury or disease; and the physical examination elsewhere demonstrated nothing abnormal.
Subsequent History. - His recovery, as concerned the injury, was satisfactory, though slow.