Intestinal stasis followed by cystic dilatation of the cæcum, without intestinal obstruction. With pathological remarks on cysts at the ileocæcal valve and on the cæcum excised, with a contribution to the pathology of intestinal stasis

Abstract

age 44, was for a number of years on the nursing staff of the Westminster Hospital ; latterly she had been engaged in district nursing, and had continued on duty until a few days before the operation. She had always been spare and a small eater : she liad been troubled by constipation, and had liad at times attacks of colicky pain. On one occasion she was medically examined, and as there was then tenderness in the ileoczcal region, the existence of appendicitis was suggested ; but the tenderness passed off without any concomitant symptoms. The abdonien had become slowly distended ; this had not been noticed for longer, certainly, than six months, and serious attcntion had only been directed t o it during the previous few weeks.It was generally concluded, on her admission, that she had a n ovarian cyst. I rxamined her fully both before and after the bowels had been moved three times following the administration of an aperient and an enema ; moreover, there was no alteration i n the abdominal tension after she was anatsthetized.The abdomen was distended by a n elastic swelling which bulged forwards ; it was dull t o percussion, and a well-nia,rkcd wave was transmitted across it. The line of dullne.:s reached midway betwecn the umbilicus and xiphoid cartilage, the upper margin varying with respiration. The flanks were flat and tynipanitic ; a finger in the rectuni did not reach the cyst.An incision in the middle line of the hypogastrium, conimencing a litt,le below the umbilicus, exposed the wall of a cyst, bluish in colour ; thc index finger passed round between the cyst-wall and the parietal peritoneum met with no adhesions. A large trocar was then plunged into the cyst, whilst the wall of the cyst was seizcd on each side of the trocar with toothed clamp forceps. It is important t o note here that the perforation of the cyst-wall was madc in the middle line of the abdomen, half-way between thc umbilicus and the pubcs. All t,hc fluid escaped at once through the trocar int>o a bucket; none leaked beside the trocar ; within a minute a completely emptied thin-walled cyst was sucked tightly around the trocar owing t o the siphonagc.The empty cyst being partly dra,wri outwards, contracted coils of intestine were noted on the inner side, and the wall of the cyst presented mriseiilar fibres. Search was now made on the outer side and to the right along tlie line of junction between the parietal and visceral peritoneum. The appendix was first shelled out, sonic six inches in length, the tip extending over the brim of the pelvis, where it was firmly fixed by a dense band. Tracing the appendix in the reverse direction, it was found continuous without any Itink, with an in€undibulum which opened into the caecum, close to wliere

Enterocyst of the Ileum, Causing Obstruction

“…The excised portion showed the structure of small intestine. Spencer and Keith (1921):" A specimen from the Museum of the Royal College of Surgeons is depicted, resembling closely the one reported in this paper. A mass was detected in the right iliac fossa and peristaltic waves appeared.…”