312 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



Intestinal calculi and concretions are also more often 

 met with in the caecum than in any other part of the 

 bowel. In distension of the colon from obstruction the 

 caecum suffers the most severely, and appears to bear the 

 brunt of the pressure exercised from within. The 

 caecum has been ruptured by forcible enemata admini- 

 stered per rectum, while the rest of the colon has re- 

 mained intact. In many cases of great fsecal accumula- 

 tion death has been due to perforation of the caecum as 

 an effect of extreme pressure, and in less severe cases 

 the peritoneum over the caecum has been found to be 

 ruptured, while it has remained sound over the re- 

 mainder of the larger bowel. This part of the intes- 

 tine is susceptible of enormous distension, provided 

 that it be gradually effected, and in certain instances 

 an engorged caecum has been found to occupy a 

 large part of the abdominal cavity. When the ab- 

 domen is opened in any doubtful case of intestinal 

 obstruction the condition of the caecum is of great 

 value in pointing to the seat of the obstacle. In 

 closure of the colon it will be found greatly distended, 

 while in obstruction of the small gut it will be empty, 

 or at least in a normal condition. 



The tip of the vermiform appendix may adhere to 

 a neighbouring peritoneal surface, and thus form a 

 " band," beneath which a piece of the small gut may be 

 strangled. It is favourably placed for the accumu- 

 lation of intestinal concretions and in it foreign bodies 

 are apt to lodge. For these and other reasons it 

 happens that ulceration of the appendix is a frequent 

 cause of perityphlitis. 



As regards the colon generally, the tendency to 

 stricture increases as one proceeds downwards from 

 the caecum to the anus. A stricture is frequent in 

 the descending colon, and is still. more common at the 

 point of junction of the sigmoid flexure with the 

 rectum. In the ascending colon it is comparatively 



