A man, aged sixty-two, when apparently in good health, was seized with violent pain in the right side of the belly and vomiting. These symptoms continued and slight jaundice developed. Three days later the vomit resembled coffee-grounds and the temperature rose to 101°. At the end of the week the pyrexia disappeared and the patient seemed much better. Three weeks after the commencement of the illness, however, he again vomited altered blood, and complained of pain and tenderness at the epigastrium. He died of exhaustion a fortnight later.
Necropsy. ' The stomach appeared to be enormously dilated, and in endeavouring to remove it it was ruptured in two or three places, and fully a quart of grey grumous fluid escaped. After tying the duodenum and oesophagus and removing the entire mass, it was found that we had really ruptured a cyst which completely enveloped the stomach, extending from the liver on the right to the spleen on the left, and closely adherent to both. It surrounded the common bile-duct, which was dilated to the size of the little finger, descended to the lower end of the vertical portion of the duodenum, and enfolded the whole of the great curvature of the stomach, forming adhesions with everything with which it came in contact. Besides the escaped fluid it contained numerous lumps of a fatty substance of the size of cardamom seeds, and loosely attached to its walls were masses of these fatty lumps, aggregated together, with black streaks intermingled. These latter were the remains of extravasated blood. The stomach showed a punched-out ulcer the size of a thumb-nail, with the open mouth of a small blood-vessel in its edge. Around it for some distance the mucous membrane was congested and covered with bleeding points. Only a thin layer of connective tissue intervened between the bottom of the ulcer and the cyst.'-H. H. Bead.
In the next case the nature of the cyst was indefinite, but from the statements regarding a ' fibrous reticulum ' and' lymphangiomatous structure' it was possibly due to the degeneration of a growth: