Recurrent intussusception—“appendix tumour”

Abstract

The patient was given an anaesthetic, and the abdomen was opened to the right of the median line below the umbilicus. After much difficulty the bulk of the intussusception was reduced, but the commencement was so fixed by firm adhesions that it could not be got out. Being in a great hurry to finish the operation, as the man's condition was getting bad, I made use of Mr. A. E. Barker's method-then recently introduced-and cut away the intussusceptum.The patient died about the tenth day from purulent bronchitis, and no postmortem examination was made. As far as could be judged, the bowel condition was satisfactory ; good evacuations were obtained and there were no signs of peritonitis. Some blood was passed with the stools almost up to the day of his death. Presumably the traction of the growth had caused prolapse of the mucous membrane af the appendix into the caecum, and this was followed by complete invagination of the vermiform process.The following case is presented, not as a surgical success, but as a pathological curiosity, and claims attention solely on account of the rarity of the condition which it illustrates.A boy, aged 4 years and 10 months, had been operated upon twelve days previously for ileo-czcal intussusception. At that time there had been severe abdominal pain for twenty-four hours, blood and mucus had passed per rectum, and a mass had been felt in the right half of the abdomen. The intussusception had been reduced by operation, the appendix removed, and the stump buried by two purse-string sutures of No. I silk. The boy had remained well until the ninth day, when he vomited once ; he continued to vomit at intervals during the next two days, and nothing was passed per rectum. On the morning of the twelfth day, when the patient was first seen, the bowels acted and a trace of blood was present in the motion ; the bowels shortly afterwards acted twice, blood being found each time. On examination, the boy lay quietly in bed excepting when attacked by a spasm of pain, during which the abdomen became rigid and the expression anxious. In the epigastric region there could be felt an elongated, transversely-disposed mass which hardened at intervals and became more easily palpable. The liver edge could not be felt, but the nature of the tumour was perfectly evident ; the apex could not be felt per rectum. The abdomen was quite flaccid, and deep palpation revealed the presence of several hard nodules, particularly in the right iliac region-these were thought to be enlarged glands.The abdomen was opened through the old incision, i.e., through the right rectus muscle at the level of the umbilicus. The apex of the intussusception was felt at the splenic flexure, but the sensation experienced was so unusual that the presence of a " leading polyp " was suspected, a theory which accorded well with the rapid recurrence of the intussusception after the first operation. By intraabdominal manipulation the apex was reduced along the. transverse colon as far as the hepatic flexure ; but here its progress was arrested, ...