. Surgery, its principles and practice . Fig. 383.—Tuberculosis op the Cecum and AscendING Colon (Hartmann). THE CECUM. 705 principally two or three hours after eating, with local meteorism, noises,and intestinal bruits. In other cases the signs of intestinal stenosisare less marked, or even completely lacking, the principal symptomremaining the slight painful crises. In the presence of these symptomsexamination of the right iliac fossa reveals a mass which can be seen aswell as felt. The tumefaction is hard, somewhat nodular, of elongatedform, corresponding to the axis of the cecum, more or l
. Surgery, its principles and practice . Fig. 383.—Tuberculosis op the Cecum and AscendING Colon (Hartmann). THE CECUM. 705 principally two or three hours after eating, with local meteorism, noises,and intestinal bruits. In other cases the signs of intestinal stenosisare less marked, or even completely lacking, the principal symptomremaining the slight painful crises. In the presence of these symptomsexamination of the right iliac fossa reveals a mass which can be seen aswell as felt. The tumefaction is hard, somewhat nodular, of elongatedform, corresponding to the axis of the cecum, more or less mobile, thismobility being freer transversely than vertically. The tumor, hmitedby a rounded contour, is more difficult to circumscribe at the level of theupper part, which is a continuation of the colon. It is indolent oronly slightly sensitive to pressure. Sometimes the tumor, in place of. Fig. 384.—Tuberculosis of the Cecum with Considerable Sclero-adipose Thickening (Hartmann). occupying the normal situation, is placed as high as the level of the upperpart of the iliac fossa. To percussion the cecal tumor does not givethe normal resonance of the bowels. The evolution of tuberculosisat the ileocecal valve may be very slow, the tardiness of developmentbeing favored by freedom from involvement of the lungs and otherorgans. Little by little, however, the patient becomes weaker, thedifficulties attending obstruction increase, and the general conditionbecomes worse. The enteroperitoneal form of the disease may succeedthe simpler form already described. The disease in any case almostinvariably progresses slowly to a fatal termination. Though very difficult to fix, the duration of the malady is usuallytwo and a half to three years. The difficulty in determining the lengthVOL. IV—45 706 SURGERY OF THE INTESTINES. of this period is dependent upon our inal^ility to decide ju
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