On varieties of the appendix vermiformis, caecum, and ileo-colic valve in man / by John Struthers.

  • John Struthers
Date:
[1893?]
Catalogue details

Licence: Public Domain Mark

Credit: On varieties of the appendix vermiformis, caecum, and ileo-colic valve in man / by John Struthers. 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.

    34/42 (page 30)
    No. 20. (Fig. 15.) Very narrow Appendix arising from back of a large caecum. Ileo-colic valve typical. Length of ccecum, from frsenal furrows, 3& inches, from ileum 2§. Diameter 3|, of colon 3£, of ileum 1 inch. The. three saccules of caecum well marked off by the three bands, within and on the surface ; bluntly rounded fundus formed by anterior saccule, dipping 'll inch below level of vestigial fossa. The fossa is an oval depression, receiving end of little finger, at upper part of equilateral triangular area, of 1 inch, formed by junction of bifurcations of the three bands. Orifice of appendix, at upper part of fossa, about & inch, bounded above by crescentic free border of & inch-long so-called valve. Seen behind, as in the figure, there is first the bulging of the vestibular fossa, and arising from it abruptly the very narrow appendix. Diameter of first f inch is only 7'5 inch, enlarging at bend to | inch. Direction at first, for nearly an inch, straight up on back of caecum, then bends abruptly inwards and down- wards. Remainder cut off, shows oval lumen of J inch. Ileo-colic valve : Ileum directed very obliquely up ; height of area of junction If inch. Formation of valve what may be called typical. Breadth of lower flap 1 inch, of upper flap §. Frcena, posterior, length to postero- external band 2, breadth at middle J inch ; anterior frsenum, length to anterior band 2, breadth £ inch. Orifice, a narrow ovoid, rounded at anterior end, pointed at posterior end ; direction horizontal, length H, breadth |, a little longer and narrower than usual. Upper margin projects inch beyond lower. No. 21. Narrow Appendix arising from back of deeply bifid caecum, and blocked. Ileo-colic orifice small. Length of ccecum, from posterior frsenal furrow 21 inches, from ileum 1|, within from valve 2 ; diameter 2f, of colon same, of ileum inch. This csecum is deeply constricted longitudinally, in front and below at anterior band, behind at postero-external band. Seen from cavity, there is a high antero-posterior septum, between the two sacs of the bifid fundus, where the anterior and postero-external bands pass along. Of these two bulging pouches the external, belonging to the anterior saccule, is the broadest, and goes furthest down, projecting f inch below notch, the internal about half that distance. Postero-external band well seen, as an elevation within and a groove on the exterior, but posterior saccule of csecum does not bulge so much as the other two. Appendix : Position of closed orifice seen by transfixing with pin from behind, close to outside of elevated septum, at inner part of recognisable triangular vestigial area. Seen behind, appendix arises above middle of back of csecum, coming out of groove between the two saccules. It is now entirely shrivelled, air having been unable to gain entrance in inflation. It has been about 2 inches in length, appears to have been pendulous, lies a little behind ileum, witli narrow mesentery between them ; mesentery seen to run along the tortuous shrivelled appendix for § of its length. Mesentery seen to carry an artery, size of good pin, from which it may be inferred that the blocking of the appendix is not of old standing. Ileo-colic valve: Ileum has medium upward direction ; height of area of junction inch ; valve remarkable ; Irani a and upper flap together form one long crescentic symmetrical fold, passing two-thirds round the intestine, reaching between the postero-external and anterior bands, and with great inclination downwards, giving a fall of f inch. Here it appeal's that the upper flap of the valve and the frsena are but one of the valvules coli more developed. Breadth at upper flap §, of lower flap £ ; freena nearly sym- metrical; length 1&, breadth at middle J inch. Orifice the smallest I have seen, but no appearance of disease ; crescentic, horizontal, length £, breadth & inch. Upper margin projects about £ inch beyond lower. This valve would be fully efficient. Other folds : The two frsena, as noted above, cease at the postero-external