Gastro-enter ostomy. — The  pathological  lesions  for  which
this  operation  is  performed  are  divided  into  two  classes  :
(i)  neoplasms  involving  the  pylorus  or  duodenum,  pro-
ducing obstruction,  and  (2)  cicatricial  contractions  oc-
cluding the  pylorus  or  duodenum.  The  most  common
cause  of  obstruction  is  carcinoma  of  the  pylorus.  In
some  cases  of  this  disease  the  obstruction  is  the  first
marked  symptom  of  its  presence,  while  in  others  it  does
not  appear  until  the  disease  is  very  far  advanced  and  the
patient  greatly  emaciated  and  cachectic.  The  disease
which  produces  the  obstruction  in  the  first  class  of  cases,
without  excision,  necessarily  terminates  fatally,  and  the
operation  of  gastro-enterostomy  in  these  cases  is  only  for
temporary  relief.  The  patient  should  not  be  operated
upon  unless  there  is  a  reasonable  chance  of  considerably
prolonging  life.  While  the  patients  may  withstand  the
immediate  effects  of  the  operation,  after  four  or  five  days
they  become  weaker  and  weaker,  until  they  finally  suc-
cumb to  the  general  depression,  to  which  has  been  added
the  depressing  effect  of  the  operation.  The  number  of
cases  of  this  variety  operated  on  by  various  methods,  and
the  results,  are  as  follows :


Murphy  :  Intestinal  Approximation.
GASTROENTEROSTOMY    FOR    MALIGNANT    DISEASE.
551


Total  number  of  operations

Method :  by  suture

Mechanical  means

Suture  with  mechanical  aid

Of  these  the  position  was  :

Side  to-side

End-to-side

Unknown

Mechanical  means  employed  :  Bone  plates..
Turnip  plate

Robinson's  segmented  rubber  plate  ....
Mayo  Robson  bone  bobbin

Murphy  button

Suture  with  mechanical  aid — means  employed,
Abbe  catgut  rings

Brokaw  segmented  rubber  rings  ....
