Röntgenographic Interpretation of Duodenal Deformities*

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Cases presenting obscure abdominal conditions, with vague and indefinite symptoms, are frequently encountered in medical practice. Most physicians have experienced the humiliation resulting from inability to diagnose correctly and treat satisfactorily cases of “biliousness,” “indigestion,” “gas on the stomach,” “heavy feeling after eating,” and various combinations of such complaints. Frequently, of course, constipation is at the root of the patient's difficulty, and there is also a very close relationship between gastrointestinal symptoms and the condition commonly diagnosed as “neurasthenia.” This is a dangerous diagnosis to make, however, unless a careful and exhaustive search has failed to reveal the presence of organic disease. Yet differentiation is essential, for it must be remembered that in cases in which the symptoms are due to so-called neurasthenia the patient can not often be relieved by operative intervention, while nothing but surgery will avail in such conditions as cholelithiasis, duodenal ulcer with pyloric obstruction, appendicitis, and so forth.

If gastrointestinal disorders always presented definite signs and symptoms, a diagnosis could be made early, and proper treatment could be instituted promptly; but many times the symptoms are so vague that the most experienced observers are unable to formulate a correct diagnosis. One reason for this is the close anatomical association of the abdominal viscera, which permits one organ to be affected by a pathological condition in another nearby, as in cases of adhesions to a diseased appendix or gallbladder. Another reason is the functional interpendence of the viscera, so that a derangement in one organ may. . .