Diseases of the intestines and peritoneum / by Hermann Nothnagel ; edited, with additions by Humphrey D. Rolleston ; authorized translation from the German, under the editorial supervision of Alfred Stengel.

  • Nothnagel, Hermann, 1841-1905.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the intestines and peritoneum / by Hermann Nothnagel ; edited, with additions by Humphrey D. Rolleston ; authorized translation from the German, under the editorial supervision of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    1007/1106 (page 959)
    lous masses in the peritoneal cavity, resembling Perlsucht in lower animals. A similar case was described by Bizzo/ero.'—Ed.] The peculiar character of the process is due to the presence of large masses of fibrin and tubercles. Sometimes the whole surface of the intestine is covered by a mass of very vascular granulations. The fibrinous material causes the different coils of intestine to become adherent to each other, to the abdominal wall, the liver, the spleen, or the pelvic organs. The mesentery is affected in the same way. The great omentum is in many cases greatly altered, and is converted into a tough mass containing fibrin and numerous tuberculous nodules, and adherent to the visceral and parietal peritoneum. The fibrinous masses often inclose cavities filled with fluid exudate, and a number of these cysts may thus be found in the same case. There is always a tendency to cicatricial contraction, which is most marked in the mesentery and the omentum. The changes thus pro- duced in the omentum have long been described; it is converted into a tough, thick cord which resembles a tumor, and is, in fact, often thought to be one during life; it runs transversely across the abdomen, or passes across the upper part of the abdomen in a diagonal direction. The mesentery also undergoes contraction. The different coils of the intes- tine may become adherent to each other and form a hard mass which also simulates an abdominal tumor; when the fluid is absorbed, the changes eventually develop that are spoken of as peritonitis deformans. As the morbid process often progresses in stages, a variety of ana- tomic appearances are often seen side by side : in one place the peri- toneum is normal; elsewhere there are a few tubercles and slight injec- tion, a fluid exudate within a fibrinous capsule, masses of fibrinous exudate that are full of tubercles, and, lastly, tough cords of cicatricial tissue. It is very important to note that in this disease the cicatricial masses may develop more rapidly than the tubercles, so that the latter become encapsulated and may thus disappear. In these cases no tubercles can be found on postmortem examination, and nothing is seen but the cicatricial tissue. This undoubtedly constitutes a spontaneous cure. (The reader should refer to the paragraphs on spontaneous cure in the pages devoted to the course and the prognosis of this disease.) The process often, however, takes a different course; perforation may occur, usually into the intestine or into other organs, or through the abdominal wall. [Pye Smith ^ refers to a case in a child in which an abscess was opened and an intestino-cutaneous fistula resulted.—Ed.] The situation of a cutaneous fistula is comparatively often either at or near the umbilicus, but perforation at this point is not pathognomonic of tuberculous peritonitis, for it is often met with in other forms of purulent peritonitis (Vallin). These features have all been described on pp. 750—763. Other serious sequelae may depend on the develop- ment of permanent adhesions. ^ Bizzozero, Morgagni, 1867, vol. ix. 2 HUton Fagge and Pye Smith, A Text-book of Medicine, 1902, vol. ii., p. 489.