Perityphlitis and its varieties : their pathology, clinical manifestations, and treatment / by Frederick Treves.

  • Treves, Frederick, 1853-1923.
Date:
1897
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Licence: Public Domain Mark

Credit: Perityphlitis and its varieties : their pathology, clinical manifestations, and treatment / by Frederick Treves. Source: Wellcome Collection.

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    colon This catarrh often passes on to ulceration It 14 by means of this catarrh that impacted fecal masses are often dislodged. Inasmuch as fecal impaction is most common in the caecum, it is no matter of wonder that the stercoral ulcer should be most common m that part ot the colon. . ., . If the ulcer acquires a sufficient depth to allow the peritoneum to be infected, perityphlitis results. To produce this condition it is not necessary that the caecum should be actually and freely perforated. Ihe following case serves to illustrate this point. A man of fifty, with advanced carcinoma of the sigmoid flexure, had the whole of the colon above the stricture occupied by retained faecal matter. In such cases ot obstruction the strain, as already said, falls mainly upon the caecum; and this patient became the subject of a well-marked attack of acute pen- typhlitis. An abscess followed, which was incised m due course. Ihe contents were very foul, but no feces had escaped. Lymph covered the caecum, but the appendix was apparently quite sound. It is perhaps needless to say that faecal accumulation may be excessive, and may even cause acute inflammation of the caecum, and yet not produce the- symptoms of perityphlitis. Thus Dr. Harley reports the case of a youth whose colon was blocked from caecum to anus with faecal matter. The mucous membrane of the bowel was inflamed and purulent. The lad died with septic symptoms, but there were no evi- dences of perityphlitis. I have met with examples of localised peritonitis about the hepatic flexure of the colon leading to suppuration in patients whose bowel con- tained masses of scybala, and in whom the acute abscess with its foetid contents could only be ascribed to a stercoral ulcer. While claiming a definite position for the stercoral ulcer in the pro- duction of perityphlitis it must be owned that the appendix may be the cause of perityphlitis and yet appear to be quite normal to the eye. Many such cases have been reported. I have met with such examples, but have found the apparently healthy appendix to be diseased when subjected to minute examination. I would especially point out, how- ever, that in these particular examples the caecum itself was also quite normal in appearance.) Further, it may be said that when a perforation of the caecum is dis- covered at the bottom of a perityphlitic abscess, it affords no evidence that the mischief began in the caecum, or that the perforation was primary. Most of the perforations so met with are secondary, the trouble having begun in the appendix, and the pus having made its way into the caecum from without. Finally, it must be allowed that the appendix is frequently infected from a diseased caecum. B. Perityphlitis taking origin from the appendix.—(a) With catarrh or ulceration of the appendix.—Catarrh of the appendix is evidently of very common occurrence. It is quite commonly found in post-mortem ex- aminations by those who are taking note especially of the condition of