A middle-aged woman was sent to us by Dr. Latham, of Barnsbury, suffering from tumour in the abdomen. It appeared from her history that she had been in good health until about four months previously, when she began to experience severe attacks of pain in the abdomen, followed by vomiting. The appetite remained good, and there was no bleeding from the stomach, but she lost much flesh and grew very weak. About a month before we saw her she noticed that her abdomen was swelling. There was no family history of importance, nor had the patient suffered from an injury. On examination she was found to be very thin, but not anaemic. The upper half of the abdomen was distended, and on palpation a rounded tumour of somewhat indefinite outline could be detected in the epigastric, umbilical, and right hypochondriac regions. The swelling was smooth, painless, elastic, freely movable with respiration, and could be appreciably displaced in all directions by pressure with the hands. The percussion-note was dull over the centre of the tumour, but sub-tympanitic over its upper third. There was no ascites or enlarged veins.
Inflation of the stomach showed that the viscus was considerably dilated and lay in front of the upper and left segment of the tumour, and the introduction of air into the colon indicated that the bowel was attached to its right side and lower margin. After a test meal the gastric contents gave a positive reaction for free hydrochloric acid and were devoid of lactic acid. The other organs of the body were apparently healthy. The pain and vomiting of which the patient complained, coupled with the fact that the stomach lay across the upper part of the tumour, seemed to indicate that the symptoms were produced by stretching of the pyloric end of the organ or the duodenum; while the physical characters of the swelling indicated that it was probably a cyst. The patient was accordingly admitted into the London Temperance Hospital for surgical treatment under the care of Mr. Paterson. When the abdomen was opened a large cyst presented itself, over the upper part of which the pyloric end of the stomach and the duodenum were tightly stretched and firmly adherent. The fundus of the stomach was dilated and situated in the left hypochondrium, and the transverse colon extended over the right margin of the tumour. An incision evacuated forty-six ounces of a brownish-coloured fluid, which contained numerous fragments of fibrin of the shape of melon-seeds and two small flakes of black pigment, but no hooklets. The cyst appeared to be situated in the lesser cavity of the peritoneum, and was so firmly adherent to the transverse mesocolon, the stomach, and intestine, that it was impossible to remove it. A drainage-tube was consequently inserted, and after about two months the cavity was almost closed. The vomiting ceased immediately after the operation, and the patient was discharged from, the hospital in good health.
In the initial stages of the complaint the pain and vomiting may require to be controlled by sedative drugs, and if the stomach is dilated lavage may be employed with advantage. As soon, however, as a cystic tumour can be detected, an operation should be undertaken, with a view to drainage. An exploratory puncture is more dangerous than a carefully performed laparotomy, and any attempt to aspirate the cyst is a dangerous procedure, as in one of the recorded cases it was followed by fatal peritonitis.