Carcinoma of the Stomach in a Girl 21 Years of Age

Abstract

The patient, M. M., aged 21 years, first consulted her physician in April, 1933, for a stomach upset with vomiting, which she ascribed to something she had eaten. He found nothing unusual on physical examination and gave her cerium oxalate and antacid, asking her to return for further examination. She called him a few days later saying that she was completely recovered. On Oct. 25, 1933, she called her physician again, complaining of continuous vomiting which she had had for one week, at times containing food she had eaten two days before, and also gas and cramplike pains in the upper abdomen. Her past history showed that she had always had stomach trouble and she was described as “picking” at her food rather than eating it. Her mother had died of a probable cancer of the stomach; the remainder of the family were alive and well. Physically, she was a small, thin girl, somewhat undernourished, with a dry tongue. On palpation, there was found a tender mass in the epigastrium in about the position of the stomach, the size being reduced by gastric lavage, and a large amount of undigested food and fluid was obtained. An x-ray examination the following morning showed the stomach to fill with poor tone and without any waves being seen. The meal stayed entirely on the left side of the abdomen, with a sharp tapered end in place of the usual antral shadow. Pressure on the media, in the manner used to fill the cap, caused a small amount of barium to shoot through a narrow canal and then outline the sphincter and duodenal cap. None of the barium remained in the canal. A mass was then palpated in the filling defect, which was movable and moved with the stomach (Figs. 1 and 2). At six hours, there was a large residue with similar findings (Fig. 3). At 24 hours, there was still a residue but the patient had vomited. The patient was operated upon on October 29. A large infiltrating mass was found to occupy the lower third of the stomach, particularly the greater curvature. A partial gastric resection with closure of the duodenum and posterior gastro-enterostomy was done. A transfusion was given and the patient was returned to her bed with a permanent venoclysis running into the leg. The post-operative course was uneventful until the fourth day, when a phlebitis appeared at the site of the venoclysis. The cannula was removed and the patient began to take fluids by mouth. Early in the morning of the eighth day, she was seized with a sudden sharp pain in the lower left chest, made a violent outcry, and sat up, becoming pulseless, cyanosed, cold, and clammy for an hour. On recovery, she complained of crampy pain in the lower abdomen, and an x-ray of the chest and abdomen showed some hazing in the lower left lung, with air beneath the left diaphragm. There was no evidence of infarct.