A man, fifty-seven years of age, complained for a long time of severe attacks of pain in the epigastrium, which were accompanied by nausea and vomiting. These symptoms occurred at irregular intervals some hours after a meal, and lasted from a few minutes to two or three hours. Each attack terminated suddenly and was followed by rumbling and gurgling over the site of the pain. The patient became very anaemic, and died from acute peritonitis. At the necropsy the stomach was found to be somewhat dilated, and a small perforation was present at the upper and anterior part of the pylorus. Three inches from the orifice, and attached to the lower border of the. organ, there was a fibrous polypus as thick as the little finger and about three inches long. It seemed probable that the occasional entanglement of the tumour in the pyloric opening had occasioned the spasmodic pain ,and other symptoms observed during life.-Cleghorn.
In other cases periodic vomiting arising from obstruction of the pylorus is the principal feature of the complaint. In Cruveilhier's case the orifice was almost obliterated by the tumour and the stomach was greatly dilated, while in that recorded by Barr Stevens a dense mass of mucous polypi, covering an area three inches square, appeared to have acted as a ball-valve during life. In this instance the patient was the subject of epilepsy, and always experienced an aura referable to the stomach at the commencement of a fit. In one of our cases there was a long-standing complaint of flatulence and acidity, but owing to the incomplete nature of the obstruction vomiting occurred only at intervals. Chemical examination of the ejecta does not afford any clue to the nature of the disease, but in the following case the diagnosis was easily made by the appearance of a detached polypus in the vomit.