. Surgery, its principles and practice . suppurationof the mucosa, withretention of the pus,the submucosa andmuscularis showing amild infiltration onlyand no tendency togangrene, but oftenperforation into themesoappendix, whichis the place of leastresistance. It resultsin a mesoappendicalmesenteric abscess (Fig. 412); the point of perforation may be not larger than theeye of a darning-needle, and when the edema and swelling of the appendix subside,the abscess may drain (Fig. 411) through the appendix into the cecum. The appen-dical wall may perforate through other portions than the mesoappendi
. Surgery, its principles and practice . suppurationof the mucosa, withretention of the pus,the submucosa andmuscularis showing amild infiltration onlyand no tendency togangrene, but oftenperforation into themesoappendix, whichis the place of leastresistance. It resultsin a mesoappendicalmesenteric abscess (Fig. 412); the point of perforation may be not larger than theeye of a darning-needle, and when the edema and swelling of the appendix subside,the abscess may drain (Fig. 411) through the appendix into the cecum. The appen-dical wall may perforate through other portions than the mesoappendical marginand cause a circumscribed intraperitoneal abscess or a peritonitis. The pus may invade the retroperitoneal or retrocecal tissues and produce whathas been called a phlegmonous retroperityphlitis or extraperitoneal fecal pus may find its exit through the posterior abdominal wall; into the freeperitoneal cavity; into the intestinal tract; or it may form a circumscribed abscessand remain weeks or months Fig. 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. Occasion
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