Peri-caecal inflammation.

  • Musser, John Herr, 1856-1912.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Peri-caecal inflammation. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    recovering from this when an acute affection of the pleura caused his death, and at the post-mortem examination there was found appen- dicitis, with ulceration and perforation, and not typhlitis, which, during life, was believed to be present alone. Dr. Wilkes agrees with Fagge in this view, and they consider that the difference in degree of the inflammation alone accounts for the difference in the symptoms, and that the largest number of cases are due primarily to inflammation of the appendix. Tliat inflammation may occur in the ctecum as it may occur in any other portion of the large intestine no one will deny. But we can say from the records of Dr. Fitz that perforation of the caecum is most rare, for in a most extensive research he was able to find but three cases, and in these instances it was due to foreign bodies. We shall, therefore, with Fagge, consider that appendicitis is the usual acute affection that occurs in the region we are discussing (see Appendix, I.). A word with reference to the anatomy. The csecum normally varies much in position as well as in shape. On the blackboard are drawings of different forms of the ctecum, as detailed by Treves in his lectures on the anatomy of the intestinal canal. He thinks that the caecum is most frequently found, not in the right iliac fossa, but on the psoas muscle itself, or in the pelvis; that the caecum is entirely surrounded by peritoneum rather than only partially, and, therefore, that behind there is no areolar tissue as was described by the older anatomists. He does not believe, moreover, that there is a meso- caecum. It is also of importance to note variations in the appendix in the consideration of peri-c£ecal inflammation. The usual position, as found by Mr. Treves and by Dr. Fitz, is behind the ileum and its mesentery, with the tip pointing toward the spleen. The second most usual position is behind the caecum with the tip pointing upward. Long appendices usually take this upward direction. Fitz also refers to its lying on the psoas muscle with or without the tip in the pelvic cavity. And, indeed, in many recent examinations I have made, this position Avas found to be most frequent. There are other variations in position. It may stretch across the pelvis and become adherent to the sigmoid flexure of the colon, and in one instance I have seen the appendix in the inguinal canal associated with hernia. In another instance it was adherent to apyosalpinx (see Appendix, II.). The appendix varies in size, it varies as regards the character of its walls, and it varies as