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77
Name Year Description of sign Signicance
Mendel [51] 1903 Gastric Ulcer
While the abdomen is relaxed, lightly percuss the epigastrium using a percussion hammer.
Healthy persons do not experience pain. In patients with a gastric ulcer, percussion identies a
point on the abdomen where the slightest blow is felt as intense pain, followed by persistent
pain. Percuss the epigastrium, proceeding radially from all directions to the designated pain
point rst found to be sensitive to pain. After connecting these points, a circular area, in most
cases, will be dened. Within this sharply dened zone, even the slightest perfusion is painful,
while outside its boundaries, even heavier blows cause no pain
Duodenal ulcers
Direct percussion of the abdomen in the epigastrium to conrm the diagnosis of a duodenal
ulcer. Directly to the right of the linea alba and slightly below the middle between the costal
arch and the navel, a sharply dened area of pain, usually, the size of two coins, is found in all
cases of duodenal ulcers
Gastric and duodenal
ulcers
Bouchard [55] 1906 A splashing sound is heard in persons with gastric dilation. To elicit the sound, the patient must
be fasting and consume one-third of a glass of water. The stomach could be dilated even if the
splashing sound is initially absent. In that case, the stomach may be attened and fall abbily
like an apron behind the abdominal wall. Ask the patient to drink one-third of a glass of water.
A splashing sound is heard over a larger region than expected in a dilated stomach. This
phenomenon is never perceptible in a healthy person fteen hours after a meal. The splashing
sound is heard below the middle of a line drawn from the umbilicus to the point nearest to the
border of the left coastal arch
Gastric dilation
Tansini [59] 1906 Protrusion of the lower abdomen caused by metastases in the lower section of the intestine from
the stomach in patients with gastric carcinoma and pyloric stenosis. Cancer localized to the
pylorus without metastases causes the abdomen to be scaphoid without ascites
Gastric carcinoma
Jonas [62] 1906 Reverse antiperistalsis of the stomach in pyloric stenosis Gastric carcinoma
Dubard [68] 1907 Chronic lung lesion in patients with pulmonary tuberculosis irritates the pneumogastric nerves’
pulmonary terminals, resulting in neuritis or neuralgia of this nerve, a trophic disturbance on the
side of the stomach, resulting in a gastric ulcer
Gastric ulcer
(continued)
3.2 Eponymous Signs
78
Name Year Description of sign Signicance
Cole [72] 1908 In the prone posture small round mucosal or submucosal ulcers are seen on oblique radiographs.
This nding occurs either immediately after the ingestion of the barium meals or two hours
later. In these cases, the stomach has no gross deformities or deep sulcus on the greater
curvature opposite the ulcer. The stomach is freely movable and not adhered to the undersurface
of the liver. These ulcers occur most frequently on the lesser curvature above the sulcus of the
angle or about halfway between the pylorus and the esophagus
Gastric ulcer
Haudek [83] 1910 Abnormal circumscribed shadows on a radiograph of the stomach arise only from the deposition
of bismuth in pathological niches of the stomach. A unique form of these niches is the
penetrating gastric ulcer, seen on radiographs as a diverticulum-like bulge of the bismuth
shadow with a gas bubble at the summit
Gastric ulcer
Günzburg [89] 1910 The tympanic percussion zone is found in an area at the quadratus lobe of the liver. This tone
can only be detected when the liver is in a normal position and the left lobe is percussed
Duodenal ulcer
Pottenger [93] 1912 Light touch palpation to delineate the borders of an organ Visceral organs
Zugsmith [99] 1912 Dullness to percussion is located at the second interspace extending for a variable distance on
both sides of the sternum in gastric ulcers, especially gastric cancer. Usually, an area of one-half
inch adjacent to the sternum is dull to percussion. However, the dullness in gastric cancer
extends toward the axilla for one, two, or more inches
Gastric ulcer
Brenner [103] 1913 A metallic rubbing sound is heard behind and below the diaphragmatic border. It is caused by
rubbing gastric uid mixed with air between the diaphragm and the dilated, bloated stomach.
The rubbing noticeable in the rst few hours after the perforation is a symptom of escaping
gastric uid. Later the brinous- purulent coating of the inamed peritoneum of the organs
below the diaphragm can also cause this rubbing
Gastric perforation
Table 3.1
(continued)
3 Stomach Signs
79
Name Year Description of sign Signicance
Prével [104] 1917 In the sitting position, where the stomach and the intestinal mass are only partially removed
from the action of gravity, an intermediate pulse is obtained. In contrast, the lowest pulses occur
in the supine position, while the highest occur during standing. Without modifying the upright
position and applying a tight belt to the hypogastric region to raise the stomach toward the
diaphragm, the acceleration occurring during standing diminishes or disappears. Passive raising
of the upper and lower body caused several subjects to slow their pulse (slower than in the
supine position)
Orthostatic hypotension
Carman [113] 1921 When the ulcer is on the vertical portion of the lesser curvature or the posterior wall near the
lesser curvature, approximation of the stomach walls by palpation causes a dark, slightly
crescentic shadow of the barium-lled crater to appear on the screen. The convexity of the
crescent is toward the gastric wall, and the concavity is toward the gastric lumen. The
resemblance to a meniscus is so apparent that the word aptly applies to the sign. Suppose the
ulcer saddles the lesser curvature distal to the incisura angularis of a shhook stomach. In that
case, the meniscus is found by palpation. However, in this instance, the base of the ulcer follows
the bending line of the curvature and the concavity of the meniscus is toward the gastric wall
Gastric ulcer
Henning
a
[119] 1937 An indirect sign of an ulcer is a deformity of the angulus. This sign occurs when the ulcer lies
close to the angulus and is produced by the folds converging toward the ulcer. Suppose the ulcer
is located immediately above or below the angulus. Instead of being the usually rounded arch, it
is pointed. In that case, the parabolic curve of the angulus is distorted by losing its roundness
and acquires the form of a Gothic arch
Gastric ulcer
Raw [123] 1944 In perforation, the onset is nearly always dramatic, with little vomiting or change in pulse and
temperature. The pain does not vary; the patient usually lies still, breathing is short and thoracic
in type, and rigidity persists
Gastric and duodenal
ulcer
a
Denotes an individual who supported anti-Semitism, racial acts, or committed crimes against humanity
3.2 Eponymous Signs
80
3.3 Conclusion
The majority of the signs of the stomach were designed to detect peptic ulcer dis-
ease and other benign conditions and, in some cases, to differentiate them from
gastric carcinoma. Pottenger size is the palpatory method for outlining the borders
of an organ and is not specic to the stomach. Prével believed that the position of
the stomach was involved in a reex accounting for changes in the pulse occurring
with changes in position. Trousseau sign, another nonspecic sign of underlying
malignancy, is included in this section as this was the disease that Trousseau had
when he recognized phlegmasia alba dolens occurring within himself. The utility of
these signs used during the physical examination is not well known since they have
yet to be studied. Radiological techniques and endoscopy revolutionized the detec-
tion of peptic ulcers and carcinoma. With it came a novel set of signs that dened
the characteristic and differentiating features of benign from malignant disease.
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3 Stomach Signs
85© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
S. H. Yale et al., Gastrointestinal Eponymic Signs,
https://doi.org/10.1007/978-3-031-33673-7_4
Chapter 4
Small andLarge Bowel Signs
4.1 Introduction
The small intestines consist of three parts: duodenum, jejunum, and ileum. The rst
part, the duodenum, is the Latin word for twelve. It was named by Herophilus of
Chalcedon (c. 335 BC–c. 280 BC) in reference to its length of twelve ngerbreadth
[1]. The jejunum, the second part of the small intestines, was described by Aristotle
(384 BC–322 BC) and named by Galen of Pergamon (129 AD–c. 216 AD). Galen
referred to this section of the bowel as “fasting,” translated into Latin as “jejunum,”
because of the absence of food in this portion of the intestines after death [1]. The
nal portion, the ileum, is the Greek term “twisted or to twist,” also believed to be
named by Galen [1]. Aulus Cornelius Celsus (c. 25 BC–c. 50 AD) was believed to
use these terms in his work De Medicina (On Medicine), in the rst century:
The junction between the stomach and duodenum, the Greeks call pylorus, because it dis-
charges the ofce of a door keeper to the lower intestines, by permitting the scape of such
things, which were about to excrete. After the duodenum, begins the jejunum, not so much
convoluted; which, as the name imports, never retains what it receives; but immediately
transmits it into the inferior parts. Thence begins the smaller intestine, or ileum, highly
convoluted; each of whose convulsions being held down by small connecting membranes;
which being turned towards the right hypogastric region terminates in the great intestine,
yet occupy more the superior parts [2, p.242].
The origin of the term colon is unclear. The caecum is the Latin term for blind in
reference to it being the blind gut or end of the large intestine. Celsus spoke about
the large intestines:
Afterwards, this intestine is joined by a thicker transverse one, which commences on the
right side, is pervious and extends towards the left, forming an arch, which is not so towards
the right, and for this reason is named the cæcum. But that portion which is open, being of
large capacity and sinuous, less tendinous than the upper intestines, and arranged in various
convolutions on each side, yet occupying the left and lower parts most, touches the liver and
the stomach: then it is connected with some small membranes coming from the left kidney;
86
and taking a curve to the right forms the descending portion, where it excretes the faces, and
on that account is there termed the straight gut or rectum [2, p.243].
Signs of the small and large bowel describe those primarily caused by obstruction,
volvulus, or intussusception. The development of uoroscopy and barium contrast
allowed visualization of the bowel and identication and delineation of the underly-
ing process.
4.2 Eponymous Signs
4.2.1 Dance Sign
Jean-Baptiste Hippolyte Dance (1797–1832) was born at Saint-Pal-de-Chalencon,
Haute-Loire, France, and was an extern in 1820 and intern in 1822in medicine [3–
6]. He received his medical degree from the University of Paris in 1826 and was an
agrégé at the Faculty of Medicine, Paris, in 1826 [3–5]. Dance was a deputy physi-
cian to Leroux; chair of internal medicine at Cochin Hospital; the Charité Hospital
in 1830; and appointed to the clinic at the Hôtel-Dieu in 1832, a position which he
held for only a short time prior to his premature death from cholera [3–5]. He was a
titular member of the Anatomical Society of Paris in 1827 [6].
Dance formulated a list of six rules of militant Cartesianism for students:
(1) You must not accept as true what I tell you about the symptoms experienced by such a
patient, only insofar as you have ascertained it for yourselves; (2) you will only have com-
plete condence about the symptom if you checked it several times yourself; (3) you will
still be afraid of having made a mistake, even when the verication appears to be complete;
(4) such a frame of mind will cause you to reconsider these things until you are entirely
sure; (5) it will make you reject everything that does not carry with it the stamp of authentic-
ity; (6) it will warn you against incomplete scientic observations. Has anyone ever said it
better? [4, p.19].
As to a description of his character by Dechambre:
Dance was one of the most distinguished pathologists of our time. He was gifted with the
most remarkable talent of observation, extreme sagacity, perseverance, and unfailing
patience, supported by a sober and lucid judgment, a spirit of induction which, within the
limited extent of experimental science, was without prejudice for or against the reigning
doctrines. He possessed a rare independent and honest scientic faith without which the
truth escapes the best intentions. Dance was easily recognized at a time when principles and
opinions were often placed before facts [5, p.385].
Dance described in three infants the following nding (Table4.1):
The cecum and the colon are displaced and reside in the sigmoid exure. In these three
cases, the shape of the abdomen is unusual. The absence of the ascending colon and cecum
on the right side of the abdomen causes a depression. In contrast, intussusception produces
a longitudinal enlarged voluminous mass on the left side [7, p.211].
Thus, Dance sign refers to depression on the right side and protrusion on the left
side of the abdomen caused by intussusception.
4 Small andLarge Bowel Signs