The indications for early laparotomy in appendicitis / by William W. Keen.

  • William Williams Keen
Date:
1891
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Licence: Public Domain Mark

Credit: The indications for early laparotomy in appendicitis / by William W. Keen. 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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    [Reprinted from the Transactions of the Medical Society of the State of New York, February, 1891.] APPENDICITIS: THE INDICATIONS FOR EARLY LAPAROTOMY. By WILLIAM W. KEEN, M.D., PHILADELPHIA, PA. In this brief paper I shall have no opportunity of entering into a relation of cases, or of alluding to the technique or to other details, but shall immediately pass to the topic assigned me. I am glad that the Committee have selected the name '•appendicitis rather than the formerly more common perityphlitis, for there is no doubt that Fitz is quite right in claiming that every case of so- called perityphlitic abscess must be regarded as primarily one of perforative appendicitis, unless proved to be the contrary, and McBurney is right in estimating that perityphlitis as compared to appendicitis exists in not more than the proportion of one to one hundred. Not that cases of properly so-called perityphlitis do not exist, but that the form which we are to discuss at the present time, namely, an abscess in the right iliac fossa, as well as many other cases without abscess, almost always arise from appendicitis, and most frequently perforative appendicitis. Matterstock found per- foration in 132 out of 145 autopsies where there was suppuration ; Fenwick, 113 out of 125 ; Weir, 34 out of 100, and Kiimmel places his percentage at 100. Hence I think the prominence that has been given of late to the appendix rather than to the caecum is amply justified by the facts. For clinical purposes /or//is of appendicitis may be recognized. First, a mild form of appendicitis without perforation, ending usu- ally in resolution without the formation of an abscess. Second, perforative appendicitis, followed by general peritonitis. This form appears in two different modes: (a) a severe, early and often fulmi- nating peritonitis, and (6), a form which is apparently mild, and, after continuing so for a certain length of time, suddenly bursts out into a disastrous general peritonitis, either from perforation of the appendix or rupture of an abscess, which sometimes has not even