OBSERVATIONS IN A CASE OF JEJUNAL FISTULA

Abstract

A case of high complete intestinal fistula has offered an opportunity for making observations on the functional activity of the upper intestinal tract, some of which have a bearing on modern interpretations of gastro-intestinal physiology. REPORT OF CASE A man, aged 38, suffered a severe crushing injury of the jejunum, Oct. 22, 1923. Dr. G. H. Copher, at the St. Louis City Hospital, resected about 2 feet of intestine and brought the free ends out of the abdomen, as an emergency measure. About 4 feet of jejunum remained above the fistula. After a stormy course, requiring two blood transfusions, the patient reacted slowly. He came under the care of one of us (E. P. L.), Nov. 1, 1923, because of alternation of services. At this time, the acute symptoms were subsiding, and the problem became for the time wholly dietary. We were confronted by a situation in which the patient