GC.12234
Joiner Age: 58 years.
This patient has had three perforations into the peritoneal cavity:
Perforated duodenal ulcer 1937
Perforated appendix 1953
Perforated ca. of jejunum 1959
History:
Duodenal ulceration from 1927 onwards. Admitted 27.11.59 as an abdominal emergency. He complained of severe pain of five hours duration. His bowels had been regular. There had not been any melaena but some mucus had been passed. His present pain was “like a perforation.”
Operation: 27.11.59 M. A. Tuner & G.H.D. McNaught.
Perforated carcinoma of proximal. jejunum. Local glands appeared to be involved and were resected with the specimen. No evidence of haematogenous or Transcoelomic spread. Portion of small bowel resected shows the perforation of the encircling carcinoma (3). The specimen is available in the demonstration.
Histology: (x7)
Shows a typical adenocarcinoma with overlying peritonitis (4.).
Further Progress:
The duodenal ulcer was still troublesome after 33 years and a Maximal Histamine Secretion Test on 4.2.61 gave 2.5 m.eq. in the pre-histamine hour and 9.1 m.eq. in the post-histamine hour.
Operation: 7.2.61 G. H. D. McNaught.
Vagotomy and gastroenterostomy for chronic duodenal ulcer. No sign of any recurrence of the carcinoma of the jejunum.
Follow Up: 25.1.62.
All well. Some slight dehiscence of the abdominal scars. Weight 13st. 3lbs. “Can eat anything.”
20.3.63. All well. Eupeptic. Clinically satisfactory.
