A man was operated on for a perforated marginal ulcer April 11, 1938, almost exactly twenty-nine years after a gastro-enterostomy had been done for a duodenal ulcer. As far as I have been able to ascertain, this is the longest interval between operation for a duodenal ulcer and the occurrence of a marginal ulcer.
The patient's record was secured from St. Vincent's Hospital in New York, where he was operated on April 29 and discharged May 23, 1909. At that time, under gas and ether anesthesia through a 3 inch incision, a typical posterior gastro-enterostomy was done. The history previous to that operation had extended over a period of two and one half years, the symptoms being marked by pain and vomiting and the vomitus being generally brownish and occasionally streaked with blood. He had put himself on a diet which gave him some relief but not complete relief. He