Periduodenitis

PERIDUODENITIS (periduodenitis), in the strict sense of the word, is inflammation of the serous coat of the duodenum, complicating various processes developing in the walls of the bowel itself; first and foremost among these must be classified duodenal ulcer as the most frequent cause of periduodenitis; considerably less frequently the basis of the disease is duodenitis (burns, intoxication). In a broad sense, the term periduodenitis is also understood to mean inflammatory processes of any other origin occurring in neighboring and sometimes distantly located organs, and secondarily spreading to the walls of the duodenum. At the base of all these forms lies the first stage of the disease. In chronic periduodenitis, rather sharply expressed periods of exacerbation are also observed, expressed by suddenly onset prolonged attacks of pain, which is explained by the exacerbation of local inflammatory phenomena. Such attacks proceed as acute attacks of cholecystitis (Mayo) and are difficult to distinguish from them diagnostically. Much more definite data are obtained in those cases of periduodenitis that are complicated by successive stenosis of the duodenum, since here, in addition, phenomena of impaired excretion of bile and pancreatic secretion come to the fore. The treatment of periduodenitis, like any peritoneal adhesions, apart from the treatment of the primary condition, consists in the prescription of thermal procedures in the form of heating pads, local mud cakes, or diathermy. With prolonged and persistent use thereof, one can count on the resorption of infiltrates and adhesions and, in any case, on the reduction of pain sensations. Surgical intervention in exceptional cases is directed squarely at periduodenitis, usually keeping other primary processes in mind. Only during the laparotomy itself is it sometimes clarified that there are no other changes to explain the clinical symptoms except for adhesions of the duodenum. In such cases, the question arises of dividing these adhesions or of other methods by which the pain and functional disturbances associated with them can be eliminated. The division of adhesions can yield a result only in cases where one is dealing with narrow, long strands giving a constriction of the bowel. In the presence of planar extensive adhesions, their simple division, even if feasible, may prove useless, since adhesions will inevitably form anew. On this basis, V. A. Oppel in his cases applied with very good results the following technique: between the divided organs, into the space obtained from the division of the "painful" adhesions, he placed a gasket from a freely taken piece of the omentum, creating thereby a new "combination of adhesions," which, however, is painless. Neighboring organs, depending on local relations, are peritonealized; the gallbladder can be sutured for the same purposes. Kehr acted more radically in cases of severe periduodenitis, removing the gallbladder even if it in itself seemed healthy, but soldered to the duodenum. In the presence of coarser changes in the organs and strictures of the duodenum, various surgical techniques must be applied depending on the case (see Duodenum).