A CASE OF AN UNUSUAL CONTRACTURE OF THE PALMAR FASCIA

G. De Swietochowski
1919 The Lancet  
IN the following strange case of swallowing a fork the patient, a domestic servant, aged 25, had .only recently arrived from the West of Ireland. It turned out to be a small dinner fork of the plated variety (62 inches long, handle 4 inches). The patient gave the following history. Having lost all her upper teetn, and having had no plate fitted, she was unable to masticate her food thoroughly. On Christmas Day she swallowed a portion of a giblet which had some difficulty in passing down the
more » ... assing down the gullet. Later she vomited, during which the undigested meat stuck in her throat" and caused difficulty in breathing. Thereupon she took a small dinner fork from the kitchen table and passed it down the throat, handle first. She dislodged the foreign body and removed the fork. The piece of meat, however, again stuck in the gullet lower down. On attempting the same manoeuvre a second time she passed the Radiogram of a fork in the stomach 48 hours after ingestion. The slight blurring at each end is due to active peristalsis. handle of the fork "a long way down." To her dismay the constrictor muscles gripped the fork, and she gradually lost her hold upon the prongs and it disappeared. The patient applied to the hospital for relief; her story was not readily believed, but it was decided to take an X ray picture. Some little delay occurred owing to the Christmas holiday, but on the 27th the photo was ready and showed a dinner fork in the stomach with the handle towards the pyloric end and the prongs towards the cardia. (See radiogram.) I was called to see her on the 27th at 6 o'clock. She was complaining of pain in the epigastrium, which was much worse when she ate anything, owing to peristalsis being excited. Nothing could be felt abnormal in the epigastrium. She was advised to have an operation for the removal of the fork. At 10.30 P.M. I did a gastrotomy through a 2-inch abdominal incision just to the right of the mid-line. There was no difficulty in identifying the foreign body. The shoulder of the fork was now lying against the pylorus, the prongs being in the stomach and the handle in the duodenum. It was removed prongs first through a -inch incision in the anterior wall of the stomach. There were a few black patches on it, possibly from the action of the stomach acid. The subsequent suture of the organ was carried out in the ordinary way, the whole operation taking under 20 minutes. The patient made a successful recovery. The accompanying radiogram was taken in the X ray department. St. Mary's Hospital. I am indebted to Mr. J. Ernest Lane for permission to publish the case. (?) CONGENITAL SYNOSTOSIS. CIVIL SURGEON, 4TH LONDON GENERAL HOSPITAL, R.A.M.C. (T.) I HAVE failed to find any reference to a case similar to the one described below in the largest libraries in London. The interest of the case is further increased by the diversity of opinions pronounced upon it. The patient, 2nd Lieutenant, aged 21, was admitted to hospital in August, 1917. Some time previously a shell had burst close by and he was buried. A fragment hit his head (small scar over right side of occiput); slight cutaneous injuries on right side. A fortnight afterwards the knuckles of both hands swelled, and were slightly tender for 34 weeks; and when this subsided he noticed his hands to be deflected; later occasional pain in hands on exertion. It was found that when extended all fingers of both hands deviated towards the ulnar side; there was loss of flexor power. The ulnar deflection was very much less obvious when the fists were clenched, the deviation increasing pari passu with the extension. Extension was limited at the metacarpo-phalangeal joints only; the inter-phalangeal joints were hyperextended. There was no loss of tactile sensation, and apparently no wasting of muscles of hands. On the contrary, the tips of the fingers looked fleshy and plump, and there were belly-like enlargements of soft tissues around the lower part of the digits, especially in middle and ring fingers. Some wasting of face, also loss of Sesh generally. The gait was normal; no deformity of toes. No other joints affected. The radiograms of both hands were normal. Family history negative. On passive movement only it was not possible to extend the fingprs and also to undo the ulnar deviation. The ilnar band of the palmar fascia to each finger was seen to !tand out like a fine cord. This could be demonstrated by
doi:10.1016/s0140-6736(00)45946-5 fatcat:eehio4lv2rdy3mxflrtpsc4voe