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

  • Sir Frederick Treves, 1st Baronet
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.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    of a porityphlitic abscess subacute obstruction may be due to kinking of the bowel, which, being adherent to the inflamed mass, was bent upon itself when the mass contracted after operation. The gut involved in these cases is usually the sigmoid flexure. Symptoms of chronic, partial, or occasional intestinal obstruction, extending over months or years, may follow from adhesions which impli- cate the coils of the lower ileum. In one case in which I operated the coils of the small intestine were matted together in inextricable con- fusion. 1 he patient had been liable for years to attacks of colic with some sickness. There was constant uneasiness in the right iliac fossa, with rumbling and gurgling in that situation, and occasional evidence of enlarged coils of bowel in uneasy movement. Inflammation of the parotid gland has been reported as a rare com- plication. It is most common about the end of the second week. I have met with one instance in which acute epididymitis occurred on the third day of a severe attack of perityphlitis. There was positive evidence that the urethra was free from disease at the time. Fcecal flstula.—A fecal fistula may result after a perityphlitic abscess. It is most usually associated with a sinus in the skin in the right iliac- region, and communicates with the caecum. The fecal sinus has been in the loin, at the umbilicus, and even at the bottom of a hernial sac. The fistulous tract may be internal, and extend between the caecum and the rectum or the bladder. A bladder fistula is very rare. The faecal fistulas now under discussion are apt to be long-abiding. They may continue for months or years, but in general terms it may be said that they show a disposition to close, and that in the course of time the great majority do close. On the other hand, they are exceed- ingly difficult to deal with by operation. Hypochondriasis.—I have said that a subject of relapsing perityphlitis —usually a man—will be met with now and then who has become quite melancholic on the subject of his disease, or at least to be hypochondriacal upon the state of his intestines. Such patients devote themselves with a morbid ardour to the ex- amination of their disorders, they are the subjects of remarkable and inexplicable symptoms, and are the recipients of an incredible variety of drugs. Mortality.—The precise risk to life of perityphlitis is a little diffi- cult to estimate. The statistics available are hospital statistics, and the cases of slight degree do not find their way into hospital wards; whereas the serious and the neglected cases are sure to be very full}'' represented. It is probable that the mortality of perityphlitis, taking all phases of the disease together—the most trifling attacks with the most serious—is about 5 per cent. Hospital statistics from which the slight attacks have near]}' all to be eliminated give a much higher death-rate. Dr. Hawkins deals with the circumstances of 264 cases admitted into St. Ihomass Hospital. Of