Perforating inflammation of the vermiform appendix : with special reference to its early diagnosis and treatment / by Reginald H. Fitz.

  • Fitz, Reginald H. (Reginald Heber), 1843-1913.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Perforating inflammation of the vermiform appendix : with special reference to its early diagnosis and treatment / by Reginald H. Fitz. 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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    In chronic cases of inflamed appendix the abscess is evident, and its treatment apparent. It may be mistaken for a psoas abscess of spinal origin. If the latter affection is present, evidence of disease of the vertebrae is usually to be obtained. In disease of the liip-joint the impaired mobility and localized sensitiveness of this articulation will be found more extreme than is apparent in the flexed and adducted thigh usually connected with a chronic peritypHitic abscess. The histories of the cases of intestinal tuberculosis, chronic suppura- tive nephritis, and cancer of the caecum are sufficient to eliminate these causes of iliac and lumbar tumors, when disease of the appendix is under consideration. Perforating inflammation of the appendix sometimes proves fatal from shock. Death usually follows from the production of a general peritonitis by the direct extension of an appendicular peritonitis, or by the rupture of adhesions producing an intervening, encysted, perito- neal abscess. A general peritonitis may also occur by the interven- tion of a mesenteric thrombophlebitis and its continuance to the portal vein and liver, with or without portal embolism. Among the 257 cases of perforating appendicitis are 11 of pylephlebitis. In the protracted cases death may result from exhaustion. Shock proves fatal within the first two days, death from an extended perito- nitis within the first week, and from a secondary general peritonitis, as a rule, during the first two weeks. The termination in resolution of a perforating appendicitis undoubt- edly occurs, but our present sources of information give no absolute evidence as to the relative proportion of this class of cases to those ending fatally. The consideration of a large number of cases of typh- litis and perityphlitis offers a suggestion as to the possible frequency. Of 180 cases thus designated there terminated By resolution 58 = 32 per cent. Spontaneous evacuation . . . . 33 = 18 “ Operation 89 = 50 “ 180 It will be generally admitted that the spontaneous evacuation of a perityphlitic abscess is an eveut to be anticipated and guarded against. Apart from the consequent dangers which may result, possible fatal complications which may precede the time of its expected occurrence