Syphilis of the Stomach: Report of Case

Abstract

On September 12, 1923, a man of 28 years was referred by Dr. William J. O'Neil, of Ashland, Pa., to the Roentgenological Department of the Ashland State Hospital for gastro-intestinal study. The patient had been treated by a number of physicians in the vicinity prior to consulting Dr. O'Neil, without relief being given and without a definite diagnosis being made, and not any of them had advised X-ray examination. Complaint.—Vomiting, and dull aching pain in the upper abdomen. Family History. — Mother died during childbirth; father, one brother and two sisters living and well. Personal History.—Usual childhood diseases. Patient has been in good health until present illness began. Denies absolutely any venereal diseases. Spent two years in the Army during the World War and was overseas. Present Condition.—Began three months ago with vomiting, and dull aching pain in the epigastrium. The vomiting would occur sometimes during the meal; sometimes as late as an hour after the patient had eaten. The pain, also, would come on either while he was eating or might be delayed for an hour or two. Vomiting afforded some relief. The man has vomited practically every meal during the last three months. Weight loss, thirty pounds. Has never seen any evidence of blood in vomitus or in stools. Physical examination was entirely negative, except that the patient was very much emaciated. No palpable tumor present in abdomen; no abnormal neurological findings. Roentgen-ray Findings.—The stomach is very small, with marked deformity of the pars media producing hour-glass formation that gives the stomach a dumbbell-like appearance. The constricted area is about two centimeters long and about the thickness of a lead pencil; there was a small retention in the upper loculus at the end of six hours. The roentgen diagnosis is lues or malignancy, and although there is a negative history of venereal disease, the patient's age and lack of cachexia would seem to indicate that the condition is luetic, if the Wassermann is positive (Fig. 1). The patient's blood was examined and gave a positive Wassermann reaction. He was sent to the Hahnemann Hospital, in Philadelphia, for treatment. He was given five weekly injections of salvarsan, and, while there was some improvement in his symptoms, his condition did not seem to warrant delay and he was operated on by Dr. A. B. Webster at the Hahnemann Hospital. An indurated, non-malignant growth was found about an inch and a half from the pylorus which narrowed the lumen of the stomach to the size of a pencil. The indurated area was incised parallel to the long axis of the stomach and closed in the opposite direction. The patient made a good recovery and went home at the end of three weeks. All his symptoms disappeared and he began to increase in weight. He was examined again at the Ashland State Hospital, December 21, 1925. The stomach was very small and showed a large filling defect in the pyloric end.