The anatomical relations of the nerves supplying the stomach are worthy of the surgeon’s especial consideration. Its sympathetic nerve supply is in particular and intimate relation with the seventh, eighth, and ninth spinal roots, by which we account for the tenderness of the overlying surface in ulcer of the stomach, and the pain which is often referred to the region of the left shoulder-blade. When the stomach is adherent to the gall-bladder, in cases of biliary calculi, the pain is often referred to the right shoulder, but so soon as the pylorus becomes entangled and bound down pain is referred also to the left side as well.
HOUR-GLASS STOMACH.
Hour-glass stomach is now more common, and is to be attributed more to results of pathological conditions than to any congenital anomaly, it being now well established that it is usually the result of perigastric adhesions of chronic ulceration, with cicatricial constriction, as well perhaps of subsequent malignant implantation. Cancerous infiltration may produce the so-called “leather-bottle” stomach. Moynihan suggests, among other methods of diagnosis, the passage of a stomach tube and lavage with a quantity of fluid. If there be loss of a certain amount of this, when it is returned, it will indicate that a portion has escaped into the distal sac of the stomach. Again if the stomach be washed until the fluid returns clear, and then if there suddenly comes an amount of offensive fluid, or if the stomach be washed clean, the tube withdrawn and passed again a few moments later, and if then offensive fluid escape, the facts can be best explained on the hypothesis of an hour-glass constriction. “Paradoxical dilatation” may also be noted, i. e., the fact that palpation will still elicit a splashing sound after a stomach tube has been passed and while the organ is apparently empty.
Moynihan has suggested still another method of recognition. The area of stomach resonance being outlined, a Seidlitz powder in two halves is then administered. After about twenty or thirty seconds great increase in resonance of the upper part of the stomach will be found, while the lower part remains unaltered. If now a bulky pouch can be felt or outlined the diagnosis is determined, as the increase in resonance occurs in the distended cardiac segment.
The method of treating an hour-glass stomach will consist either, in selected cases, of a plastic operation by which an incision made in one direction is closed in the opposite, i. e., a measure like that practised at the pylorus for benign stricture, or else the separate sacs of the stomach must be united by an anastomotic opening and a gastrogastrostomy thus performed.
FOREIGN BODIES IN THE STOMACH.
These are most commonly those which have been swallowed, either by design or through inadvertence, and may consist of almost all imaginable substances. In those animals that have the constant habit of licking their own fur or that of others, and thus scraping off a quantity of hair, hair-balls in the stomach are frequently formed, and, as may be seen in museums, these sometimes obtain relatively enormous size—a foot or more in diameter. Hair-balls in the human being are of rare occurrence, and are the result of the habit of chewing the hair, observed in some hysterical or insane patients. There are several instances now on record of successful removal of such hair-balls from human stomachs. Artificial dentures, partial or complete, are not infrequently passed into the stomach, sometimes during sleep. In dealing with a case of this character extreme caution should be exercised, because many individuals have deceived themselves, or have been deceived, and the missing teeth supposed to have been swallowed have been found in some place where they have been mislaid and forgotten. Children have a habit of swallowing almost anything left loose in the mouth, and all sorts of toys and small playthings have disappeared into their stomachs, sometimes causing death, and occasionally passing through the alimentary canal. The insane sometimes show a maniacal tendency to swallow foreign bodies, such as nails or anything else which they can get into the mouth. Hysterical patients and museum freaks evince the same habit, and it is wonderful how tolerant the stomach becomes in some of these individuals, and what objects seem to pass the pylorus and escape externally without doing serious harm. Still, sooner or later nearly every one of these individuals comes to grief. Thus from one patient at the Erie County Hospital, in Buffalo, Gaylord removed an astonishing amount of junk, including nails, screws, pieces of glass, knife-blades, and the like. As a general rule, any reasonably smooth object which can pass through the esophagus may also pass through the pylorus.
Symptoms.
—The symptoms produced by these foreign bodies will vary according to their size, number, and character. A hair-ball may lie for a long time within the stomach, producing few symptoms, and none by which it may be recognized. So long as no perforation of the entire thickness of the stomach walls occur, nor any infection which may produce a local peritonitis, the disturbances they set up may be limited to those included under the name “dyspepsia.” So soon, however, as pain, tenderness, or septic indications, or those of local peritonitis supervene, the abdomen should be promptly opened. Today we have the cathode rays as an aid in diagnosis, which will clear up doubt in most instances, and afford a definite indication for operation. Nevertheless a negative result does not necessarily imply that no foreign body is present.