Stomach

Stomach (Gr. UTeµaxos from UT6pa, a mouth), the bag-like digestive organ which in man is situated in the upper left part of the abdomen. See, for anatomical details, Alimentary Canal. For the diseases of the stomach in general see Digestive Organs; and for special forms Gastritis, Gastric Ulcer, Dyspepsia, &C.; also Abdomen (Abdominal Surgery). Cancer of the Stomach is a common disease. It occurs for the most part in persons at or after middle life, and in both sexes equally. Its favourite situation is the outlet (pyloric cancer), where a hard, fibrous growth forms a contracting ring of the scirrhous variety. But when cancer attacks the inlet of the stomach, the tumour is of the scaly epitheliomatous variety. It often begins in the tissues of the end of the gullet, spreading downwards to the stomach. Chronic gastric ulcer is not unfrequently the starting point of cancer.

The symptoms of cancer of the stomach are apt to be indefinite (for many weeks or months). There may be long-standing complaints of "indigestion," which is sometimes made better, sometimes worse, by taking food. Then comes a feeling of discomfort which can be often localized, the individual pointing with his finger to a spot somewhere behind the end of the breastbone. Difficulty and pain in swallowing may be complained of when the cancer is beginning to block the inlet, but if it is situated at the pylorus the discomfort comes on an hour or two after a meal - at the time that the partially digested food is trying to make its way into the small intestine. Much of the food remains in the stomach and, undergoing fermentation, causes the evolution of gas which distends the stomach and gives rise to unavoidable belching. Later on vomiting occurs. The vomiting may take place every two or three days, enormous quantities of undigested food mixed with frothy, yeast-like mucous being thrown up. And whilst the stomach is slowly filling up again after one of these uncontrollable emptyings, sudden and violent movements of the individual may cause the fluid to give rise to audible "splashings." But even at this stage the disease may be unrecognizable, though the symptoms are extremely suggestive. But later the vomited matter is blackened by blood which has escaped into the stomach from the ulcerated growth. The patient then rapidly loses flesh and strength, and a hard lump may be felt in the upper part of the abdomen.

A characteristic feature of cancer is the carrying of the epithelial cells (which are the essential element of the growth) to the nearest lymphatic glands, and in cancer of the stomach the secondary implication of the glands may cause the formation of large masses between the stomach and the liver, which may press upon the large veins and give rise to dropsy. Secondary deposits are apt to form also in the liver and they may cause the appearance of a bulging below the ribs on the right side.

Another characteristic of cancer is that it spreads far and wide, drawing other tissues to itself by contracting fibrous bands. These are sometimes erroneously spoken of as the "roots" of cancer, and in the case of cancer of the stomach they may fix it to the pancreas, the liver, the bowels or the spine. The invasion of the lymphatic glands and the spreading of the growth into neighbouring organs, render the successful operative treatment of gastric cancer hazardous and disappointing. By the time that a tumour has made itself recognisable the probability is that it is too late for the attempt to be made for its removal. But in many cases the patient prefers that the abdomen should be opened for exploration for a possible operation than that he should hopelessly give himself over to the disease. And sometimes the surgeon is enabled by operation to give great relief, though the removal of the growth itself is impracticable.

When the growth is at the cardiac end of the stomach, blocking the gullet and causing slow starvation, the abdomen may advisedly be opened, and, the stomach having been fixed to the surface-wound, a permanent opening may be arranged for the introduction of an adequate amount of food. This operation is called gastrostomy  and may be the means of giving many weeks of comfort to the unhappy patient - provided that its performance is not too long postponed. In the case of pyloric obstruction a permanent opening may be established between the stomach and a neighbouring piece of intestine, so that the food may find its way along the alimentary canal greatly to the relief of the symptoms of gastric dilatation. This is called "short-circuiting." In some early cases of pyloric cancer resection of the disease may be performed, the upper end of the intestine being afterwards joined to the middle of the stomach by a kind of short-circuiting operation. In certain rare cases the whole of the stomach has been removed, the bowel being brought up and spliced to the end of the gullet.

In the case of gastric dilatation from pyloric obstruction great relief may be afforded by washing out the viscus by means of a long rubber tube, a funnel, and a jug of hot water, as originally suggested by Adolf Kussmaul.

## Pyloroplasty

Simple fibrous narrowing of the gateway of the stomach or of the intestine is dealt with by dividing it longitudinally and then suturing the edges of the wound transversely. This ingenious operation widens the track at the expense of an unimportant fraction of its length. In cases of great dilatation of the stomach with no obstruction to the outlet the slack of the walls may be gathered up by pleating and so permanently secured by suturing. Loreta's operation for dilatation of the outlet of the stomach is now rarely performed. (E. O.*)