Gastrojejuno-Colic Fistula


Case I

A man, 45 years of age, presented himself at the Clinic on July 21, 1931, complaining of “stomach trouble.” He stated that 11 years previously he had first noted epigastric, gnawing pain, which came on from one to three hours after eating. During the night he would be awakened by the same type of pain, which was always relieved by eating, by alkalies and by drinking milk. He had been on Sippey diet several times by the advice of various physicians, and six years before, he had received medical treatment for “ulcer” for one month at Lakeside Hospital. He was comfortable while under medical treatment but the pain recurred as soon as he discontinued the Sippey diet. Becoming discouraged with medical treatment he sought surgical relief and was admitted to Charity Hospital in September, 1929, where I first saw him on Dr. C. A. Hamann’s service. The patient was then complaining of this same type of pain, of the “belching of considerable gas” and at times of nausea without vomiting. The preoperative diagnosis was duodenal ulcer.

He was operated upon by Dr. Hamann who made the following note: “There is a marked indurated ulcer right at the pylorus, adherent to the under surface of the liver and gall bladder. There is quite a mass, very firm to touch. No stones in the gall bladder. It was thought best not to separate it from the gall bladder and liver. One or two stitches across the pylorus were put in.