Tin \ir i ii wi- m. 



normal passage through the sphincter and, 



none leaves bj the fistula. When the pylo - parti 



food sometimes passes in the usual way, and sometimes by I 



The cause for this predilection for the pyloric pathv 



pressure conditions in the gastric contents G 



fore, is efficient only when gross mechanical obstruction i 



pylorus. The operation should never be performed in 



demonstrable organic pyloric disease. 



Another objection to gastroenterostomy in the p 

 pyloric sphincter rests on the fad that the food, after pae 

 ter and moving along the intestine, may again enter the stomach through 

 the fistula. This is most likely to occur when the stomach is full 

 food, for under these conditions the stretching of its walls s< 

 edges of the opening, the intestine being drawn taut bel 

 so thai the opening between the stomach and the inti 

 form of two narrow slits, which act like valves permitting 11 I to 



enter bu1 preventing its escape from the stomach. Only seldom un< 

 these circumstances can any food pass into the inl beyo 



stomach opening. Repeated vomiting after gastroent ny has 



observed in experimental animals only when obstructive kink- ther 



demonstrable obstacles were present in the L r ut. the obstruction being h>- 

 cated in thai pari of the intestine beyond its attachment to the stomach. 



When the pyloric obstruction is complete, food n 

 by the fistula, digestion by the pancreatic juice and I > i 1 « - being still c 

 ried on because of the fad that for a considerable distance down 

 intestine, secretin, which we have seen is ess< tial for the tion 



of these fluids, is still produced by the contact of the acid chyme with 

 the intestinal mucosa. Further provision for adequate dig' 

 food in such cases is secured, as some of the food after leavii 

 fistula passes back for a certain distance into the duodenum, \\ i 

 it sim. n excites peristaltic waves, which again carry it i 



insures thorough mixing with the digestive ju 

 menial experience Cannon and Bla ommend that, when the 



fistula has to be made, it should be as l;ii\ 



pylorus, and that the stomach afterwards should i 



become filled with f 1. To avoid kinkii >m> 



mend thai several centinx »f the intestine should 



stomach distal to the anastomo? 



The elTeet of h fl }>< niciil "it \J of the route!'. the 



Stomach has 1 n studied l>\ fei animals with I 



varying percentages of hydrochloric acid. With 



