. Surgery, its principles and practice . he acute andintermediate operations in inguinal hernial sacs. A pathologic appendixmay be situated on the left side, either in cases of transposition of viscera. 744 SURGERY OF THE APPENDIX VERMIFORMIS. or without such transposition. We found the entire appendix to theleft of the median line in two cases. In one it was adherent to the lefttube and in the second to the transverse colon. In many of the acute,and even in the intermediate cases, the tributary lymph-nodes in themesentery are enlarged. Occasionally they may suppurate, even afterthe subsidence
. Surgery, its principles and practice . he acute andintermediate operations in inguinal hernial sacs. A pathologic appendixmay be situated on the left side, either in cases of transposition of viscera. 744 SURGERY OF THE APPENDIX VERMIFORMIS. or without such transposition. We found the entire appendix to theleft of the median line in two cases. In one it was adherent to the lefttube and in the second to the transverse colon. In many of the acute,and even in the intermediate cases, the tributary lymph-nodes in themesentery are enlarged. Occasionally they may suppurate, even afterthe subsidence of an attack. In chronic appendicitis the organ showsan infiltration and thickening of the walls, which, together with enlargedlymph-nodes, may suggest either malignancy or tuberculosis; it istherefore imperative to dissect out one or two lymph-nodes for diagnosticpurposes. An appendix which has been subjected to repeated inflam- ^^^.^-^^^^^ -^^^ cr*?« ^ ^^^fiCA^^^ Fig. 416.—Carcinoma of the Vermiform Appendix (Rolleston and Jones).. mations, especially in individuals past forty, may be partly or totallyobliterated. In other words, obliteration may be the sequence of repeatedpathologic processes in the appendix or it may be a physiologic atroplw. The vermiform appendix may be invaded by tuberculosis or actinomy-cosis; it may be involved in typhoid fever. These conditions Avill beconsidered under the special forms of appendicitis. Intestinal parasites may find entrance into the appendix and producean inflammatory reaction. The ordinary round-worms have been re-peatedly found. The echinococcus was found in the appendix bv Schollerand Birch-Hirschfeld. Still, in two hundred autopsies in children under TYPHLITIS, PERITYPHLITIS, EPITYPHLITIS. 745 twelve years, found the oxyuris in thirty-eight cases, it being presenttwenty-five times in the appendix. Hoppe-Seyler reported a case of amebic enteritis in which the amoebacoH produced an inflammatory reaction in the appendix. Neoplas
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