Ferity phlitis 327 



lies in the right iliac fossa, or rests upon the psoas ; it may even, 

 like the sigmoid flexure, hang over into the true pelvis. Above it is 

 carried on as the ascending colon, 

 and on its inner side the ileum enters 

 by the ileo-cascal valve. It is about 

 2^ in. deep and the same across. 



The vermiform process, 3 or 4 

 in. long, and, completely ensheathed 

 by peritoneum, is curled up along the 

 left aspect of the caecum. Under its 

 serous coat are muscular and mucous 

 layers, as in the caecum itself. A shot- 

 corn, seed, or faecal concretion lodged 

 in the process may cause a localised 

 peritonitis and inflammation of the 

 neighbouring tissues generally ; the 

 condition is named perityphlitis (nepi, 

 around ; ruc^Aos, blind). The tissues 

 become matted together. In due 

 course ulceration or gangrene of the 

 process occurs, fasculent matter es- 

 caping, and suppuration advancing. 

 The disease is characterised by hard- 

 ness and tenderness deep in the right 

 iliac fossa. The inflammation of the 

 muscular coat of the bowel entails paralysis of its fibres, constipation 

 being the result. The constipation is beneficial in that it keeps the 

 parts at rest and encourages the formation of adhesions which may 

 shut the abscess out of the general peritoneal cavity ; opium, not pur- 

 gatives, should be prescribed, and leeches may be applied. The abscess 

 should be opened through the iliac fossa, or it may discharge into the 

 colon, or may wander into the pelvis ; its bursting into the peritoneal 

 cavity is always to be dreaded. Small hard masses are sometimes 

 found in the vermiform process, which, though much resembling 

 cherry-stones, are found on section to be formed of inspissated intestinal 

 secretion. 



In two cases of acute peritonitis in children which were under my 

 care we found that the cause of the trouble was an ulceration over a 

 concretion in the root of the process. I ligatured and amputated the 

 process, and washed out the peritoneal cavity, but, unfortunately, the 

 children sank shortly afterwards. In the case of recurrent typhlitis an 

 exploratory laparotomy, and amputation of the vermiform process, may 

 be indicated ; it must be remembered, however, that the ureter lies close 

 in the neighbourhood and may possibly be implicated in the adhesions. 



The surgery of the vermiform process is of far more interest than is 

 its anatomy. 



Left lumbar colotomy. (HERBERT 

 ALLINGHAM.) 



