Gastric Ulcer Demonstrated by the Gas-Filled Stomach: Case Report

Abstract

The patient was an unmarried female, aged 23, who entered the hospital February 7, 1926, with a temperature of 105.6° and the following chief complaints: Headache; abdominal pain; lumbar pain; vaccination on right thigh. Patient felt ill on the day preceding her entry to the hospital, had severe back pains and complained that “all her bones felt as if they would break.” Vomited several times before entering hospital; vomitus after entering was of greenish hue. Had abdominal pain and epigastric tenderness, but no diarrhea. No jaundice, no cough nor dyspnea since day of entrance, when back pain seemed to cause difficult respiration. Physical Examination. — (Abdomen) Slight area of distention in epigastrium, with regional tenderness. The lower abdomen was quite spastic; no tenderness; no marked rigidity. Tender area over region of stomach and pancreas. (Extremities) Vaccination area on right thigh. Progress Record February 8: Reaction from vaccination can account for all symptoms. February 10: Epigastric tenderness and some muscle spasm in this region. Vaccination not causing symptoms now, and evidence of pathology in upper abdomen quite marked. February 11: Pain and tenderness in upper abdomen suggestive of acute pancreatitis. Tenderness most marked on left side of abdomen near costal margin and area of left kidney. Impression is that of general blood infection, possibly from vaccination, but could be from other focus. February 12: Chest clear, no râles; heart regular, rapid, no irregular sounds ; extreme tenderness left kidney and spleen area; nausea produced by turning on right side. February 13: Left kidney area distinctly more swollen and tender, more marked than any other portion of the abdomen; right kidney area soft; twelfth rib easily felt; left rib cannot be felt. Advise X-ray of this area. X-ray Findings The radiograph showed both kidneys normal in size and position, with no evidence of calculus. Patient was much worse on the two following days and a radiograph of the epigastric region, including the upper border of both diaphragms, was made; this was the examination that showed up the gas-filled stomach. The X-ray work was done by portable as it was impossible to move the patient. The X-ray report of the epigastric region is as follows: “This shadow includes both diaphragms and extends down to the fourth lumbar. The diaphragms are apparently normal. There is a calculus about the size of a French pea, in the region of the pelvis of the right kidney. The stomach is well outlined, being markedly distended with gas. Pylorus is well up under the right costal margin, while the cardiac portion is pressing the left diaphragm. Underneath this we find a heavily outlined gas-filled transverse colon, showing in hoth the hepatic and splenic flexures.