564 



THE DIGESTIVE SYSTEM. 



udative inflammation with necrosis. In this way small or large portions of 

 the wall of the appendix are destroyed, large or small perforations are 

 formed, and the contents of the appendix escape into the abdominal cav- 

 ity. In these cases the appendix usually contains a faecal concretion. 

 Such perforations are usually followed by the collection of pus around 

 the appendix (Fig. 339). The pus may extend from this abscess-like 

 collection in any direction and for long distances, so that collections may 

 be found deep in the pelvic cavity, or under the diaphragm, or abscesses 

 may form at other remote points. 



4. The entire appendix becomes gangrenous within one or two days, 

 with the formation of an abscess, or general peritonitis. This is the most 

 fatal form of appendicitis. 



5. Inflammation of the appendix may be secondary to catarrlial or 

 croupous colitis. 



6. In typhoid fever there may be changes in the wall of the appendix 

 of a character similar to those in the wall of the small intestine ; that is, 

 hyperplasia of the lymph oid tissue with necrosis. 



7. There may be a tuberculous inflammation of the appendix, with the 

 formation of ulcers. 



As the result of chronic inflammation in the appendix, atrophy of the 



FIG. 340. CHRONIC APPENDICITIS. 



Showing obliteration of the glands and lytnphoid tissue with new flbrous tissue in the nmcosa and 

 submucosa. 



glands and lymphoid tissue with increase of the fibrous tissue (Fig. 340) 

 and strictures or obliteration of its lumen may occur (Fig. 341). 



The lumen of the appendix frequently contains concretions of faecal 

 material which have often been mistaken for foreign bodies. Foreign 

 bodies, such as grape and apple seeds, and various small objects whicli 

 have been swallowed, sometimes, though rarely, find their way into the 



