A man, aged twenty-one, was admitted into the Radcliffe Infirmary on June 28, 1895. His illness commenced about twelve months previously with pain across the upper part of the abdomen and vomiting. These symptoms had increased in severity during the last six months. On one or two occasions the vomit was blood-streaked. Pain did not seem to be affected by food.
On admission the patient looked anxious and very ill. Nothing was discovered in the abdomen to account for the pain and vomiting. While in the infirmary he vomited daily, and often complained of severe abdominal pain. Bowels confined. He was put on a fluid diet.
On the evening of July 10 the patient was seized with more than usually severe pain, and the vomiting became urgent. The following morning a distinct tumour could be made out, running obliquely across the abdomen from right to left. This was considered to be most probably an intussusception, and it was decided to open the abdomen. On this being done a large intussusception was found, commencing a few inches from the pylorus. It was easily reduced, but the patient's condition did not improve, and he died about twenty-four hours after the completion of the operation.
July 12.-On post-mortem examination an enormous number of polypi were found, varying in size from a pigeon's egg to a pea; they were scattered throughout the stomach and small intestines, the greatest number being in the duodenum and upper part of the jejunum. Many of them were furnished with long pedicles (fig. 61). W. Collier.
Multiple small polypi in the stomach, being rarely accompanied by any symptoms of importance, can seldom be recognised during life. In the only two cases where a successful diagnosis was made unmistakable evidence of the disease was afforded by the appearance of a polypus in the vomit. In Beardsley's case, already cited, the tumour was apparently detached during an attack of violent retching, while in the other it became entangled in the eye of a stomach-tube, and was thus removed (Debove). Even when the pylorus is partially obstructed no tumour can be detected, and the concomitant pain and haematemesis usually suggest the presence of an ulcer rather than of a growth.
Pedunculated adenomata accompanied by a palpable tumour are exceedingly rare, and closely resemble cancer or fibrosarcoma of the stomach. Indeed, notwithstanding the cases of benign adenomata recorded by Chaput, Hinds, and others, we are strongly of the opinion that all palpable tumours occurring after middle life and accompanied by progressive symptoms are really malignant in character.
This resolves itself into the treatment of symptoms. If the stomach is dilated the employment of lavage with an appropriate diet will afford relief, while in cases where spasmodic pain is a prominent; feature of the disease recourse must be had to opiates. The presence of a movable tumour connected with the stomach should be regarded as an indication for surgical interference.