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A case of intestinal obstruction by a gall-stone

1905; Springer Nature; Volume: 120; Issue: 3 Linguagem: Inglês

10.1007/bf02964128

0790-231X

T. E. Gordon, William M. A. Weight,

Biliary and Gastrointestinal Fistulas

Mrs. F. F., aged seventy-three years; bore seventeen living children, and has been very healthy all her life, with the exception of two or three illnesses connected with child-bearing, one being an attack of abdominal inflammation and another of phlegmasia alba dolens.On the night of February 12th, 1904, she was taken suddenly ill with an extremely acute attack of pain in the hepatic region, accompanied by vomiting; this was relieved by hypodermic injections of morphia.Two days after the patient was, distinctly jaundiced, and I had no doubt at the time the pain was due to the passage of a gall-stone.Af~er the acute pair~ subsided, a good deal of tenderness persisted over the region of the gall-bladder for a month; her temperature was slightly raised, her tongue furred, her bowels constipated, her appetite poor, and, in fact, from February 12th until the middle of Apri[~ she was not well, suffering from what I looked upon as a condition of slight choleeystir brought on by the discharge of the gall-stone.Early in May she seemed to be perfectly well, so far as any liver or stomach trouble was concerned.On the 3rd of June she got an attack of phlebitis in one of the superficial: veins of her right leg, which completely disappeared before the end of the month, and again she seemed quite well.On Saturday e~cening, the 6th of August, I was sent for and found her suffering from intense pain in the pit of the stomach.This had begun the evening before as a sensation of fulness, which had gradually increased until it became acate pain.Her son, who was a medical' man, and staying in the house, had given her twenty-six drops of Collis Browne's chlorodyne without effect.I gave her 88 gr. of morphia hypodermically, and ordered poultices to be constantly applied.I also left a dose of 30 minims of nepenthe, to be taken if the pain was not better.I was sent for early the following morning, as she had had a wretched night--sleepless, retching, and in constant pain, which none ef the opiates had relieved.I found her looking very anxious; there was no rise Read before the Section of Surgery in the Royal Academy of Medicine in Ireland on Friday, December 2, 1904.[For the discussion on this paper, see u CXIX., page 219.]