572 THE DIGESTIVE SYSTEM. 



lungs or genito- urinary organs or intestines ; or it may be an independent 

 process. The process may be local or general in the peritoneum. The 

 lesions may be miliary in character (Fig. 347) or there may be large foci 

 of new-formed tubercle tissues with considerable necrosis. There may 

 be more or less serous or sero-fibrinous or purulent or hsemorrhagic ex- 

 udate. Fibrous adhesions may form between the intestinal coils and the 

 peritoneal walls with the encapsulation of exudate. Ulceration of the 

 tubercle tissue may occur, or it may become dense and fibrous and is then 

 often pigmented. The tuberculous inflammation may be limited to the 

 vicinity of tuberculous ulcers of the intestine. It may involve the omen- 

 turn, which is converted into a hard, thick, dense mass at the upper part 

 of the abdominal cavity. ' 



TUMORS. 



Fibromata are developed from the subperitoneal connective tissue and 

 project inward into the peritoneal cavity. They are found beneath the 

 parietal peritoneum and that covering the intestines. Such tumors may 

 reach a very considerable size. Papillary fibromata of the peritoneum 

 (Figs. 348 and 446) may be secondary to papillary fibroma of the ovary. 



Lipomata. Circumscribed tumors composed of fat tissue are formed 

 beneath the intestinal and parietal peritoneum and in the mesentery. 

 These tumors may become changed into fibrous tissue or calcified. Their 

 pedicles may become atrophied so that they are left free in the peritoneal 

 cavity. 



When they grow beneath the parietal peritoneum they may form fat 

 hernise. At the umbilicus, in the inguinal canal, along the vas deferens, 

 in the crural ring, and in the obturator foramen, fatty tumors may grow, 

 project outward under the skin like hernise, and, by drawing the perito- 

 neum after them into a pouch, may open the way for a future intestinal 

 hernia. 



Very large retroperitoneal and perirenal lipomata are of occasional 

 occurrence. 2 



Eetroperitoneal sarcomata are found both in children and adults. 

 They usually originate behind the peritoneum, covering the posterior 

 part of the abdominal wall, and may grow between the folds of the 

 mesentery. 



They may be of the small spheroidal -celled type (lympho-sarcoma) or 

 of the fusiform -celled type. They are often very vascular. At first 

 they grow slowly inward, pushing forward the peritoneum and abdominal 

 viscera. After a time they assume a more noxious character, infiltrating 

 the soft parts with which they come in contact, and forming metastatic 



1 For bibliography with reference to operative treatment see Bottomley, Reports 

 Boston City Hosp., ser. 11, p. 118, 1900. For a full critical summary of the literature 

 of peritonitis from 1885 to 1900 see Bumm, Centralbl. f. Path., Bel. xii., pp. 1 ? 65, 1901. 



2 For bibliography of such tumors see Adami, Montreal Med. Jour., vol. xxv., pp. 

 529, 620, 1897. 



