. Surgery, its principles and practice . ig. 412.—Illustrating Mesenteric Abscess. TYPHLITIS, PERITYPHLITIS, EPITYPHLITIS. 741 The above descriptions refer to the acute process. In the chronicform the lumen is partly obliterated by adhesions or as a result of hyper-plasia; the mucous membrane is then rather fibrous in may contain one or several calculi. The appendix now assumesvarious shapes, depending upon the position in which the external adhe-sions fix it to neighboring structures. In places it is constricted or flexedby adhesions and the constriction corresponds to an oblite
. Surgery, its principles and practice . ig. 412.—Illustrating Mesenteric Abscess. TYPHLITIS, PERITYPHLITIS, EPITYPHLITIS. 741 The above descriptions refer to the acute process. In the chronicform the lumen is partly obliterated by adhesions or as a result of hyper-plasia; the mucous membrane is then rather fibrous in may contain one or several calculi. The appendix now assumesvarious shapes, depending upon the position in which the external adhe-sions fix it to neighboring structures. In places it is constricted or flexedby adhesions and the constriction corresponds to an obliteration of thelumen. Its wall may be infiltrated, its neck occluded, and a retention cystmay have developed. The tip of the appendix may become adherent todistant organs, as the female genitalia (see Fig. 413), the rectum, liver,gall-bladder, spleen, etc. In many instances it may be so displaced anddistorted that a careful dissection is required in order to restore itsoriginal position. Occasionally the tip may be adherent to the iliac. Fig. -Vermiform Appendix Adherent to Right Ovary and Tube with Abscess in the Pelvis. vessels, as normally they are in close proximity. Now and then, theappendix may be entirely absent, as the result of auto-amputation, asequence of destructive pathologic processes. It may be found adherentwith its tip on some distant organ and the base floating free in the ab-dominal cavity, or the appendix may have become gangrenous andbeen eliminated through the iDowel with the pus. The appendix may be the seat of a tuberculosis, with the same dinical mani-festations as in the acute infections, or with symptoms of chronic every case of suspected tuberculosis either the ocular or hypodermic tuberculintest should be made. In the former one drop of a 1 per cent, solution of Kochstuberculin (old) in normal salt solution is dropped into the conjunctival sac; the 142 SURGERY OF THE APPENDIX VERMIFORMIS. first symptoms of a positive reaction a
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