. Surgery, its principles and practice . nnective-tissue growth, secondary cicatricial con-traction, and consequent stenosis of the bov/el. Rotter and Mayo haveshown that these stenoses are produced by chronic inflammatory processesin the deeper layers of the gut wall and not by cicatricial contraction 670 SURGERY OF THE INTESTINES. of the mucosa. The mesentery also is frequently thickened. Thus thedifferentiation from carcinoma is impossible without a microscopic ex-amination. To this latter type Wilson (Mayo) suggests that the termperidiverticulitis should be applied. Etiology.—The majority
. Surgery, its principles and practice . nnective-tissue growth, secondary cicatricial con-traction, and consequent stenosis of the bov/el. Rotter and Mayo haveshown that these stenoses are produced by chronic inflammatory processesin the deeper layers of the gut wall and not by cicatricial contraction 670 SURGERY OF THE INTESTINES. of the mucosa. The mesentery also is frequently thickened. Thus thedifferentiation from carcinoma is impossible without a microscopic ex-amination. To this latter type Wilson (Mayo) suggests that the termperidiverticulitis should be applied. Etiology.—The majority of the patients are over fifty years of are frequently obese and generally give a history of feces probably favor the ulceration. Symptoms.—Peridiverticulitis gives rise to all the symptoms ofstenosis of the sigmoid, associated with pain in the left side, and a masswhich is tender, hard, and irregular. The patient is frequently anemicand has lost weight. Thus we see that the differential diagnosis from. Fig. 373.—Hodenpyls Specimen of Multiple Acquired Diverticula, of the Colon (Sig-moid Flexure) (Brewer). carcinoma is almost impossible without exploratory incision and micro-scopic examination. These cases may be associated with fistulas in-volving the bladder or abscesses in the mesentery. Diverticulitis associated with rupture may be followed by peritonitis,either local or general, and consequently gives the symptoms and signsof these conditions. If an abscess forms, it lies in the left inferior quad-rant of the abdomen. The involvement of the bladder in these casesoccurs with sufficient frequency to cause comment. No less than sevenof the twenty-four cases mentioned by Beer and Mayo had a fistula con-necting the gut and bladder. Differential Diagnosis.—The diagnosis must be made from car- DIVERTICULA. 671 cinoma, actinomycosis, tuberculous peritonitis, chronic sigmoiditis, left-sided appendicitis, and, in the female, adnexal disease. Pr
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