chap, xvn.] ABDOMINAL VISCERA. 343 



accumulation of faecal matter is very usually met with 

 in the caecum, and upon that part of the bowel when 

 distension is extreme the greatest strain usually 

 comes. 



Stercoral ulcers (ulcers due to the pressure and 

 irritation of retained faeces) are more often met with 

 in the caecum than in any other part of the colon. 

 Intestinal concretions also are not uncommon in this 

 part. 



The caecum is susceptible of enormous distension, 

 provided that it be gradually effected, and, in certain 

 instances, a dilated caecum has been found to occupy 

 a large part of the abdominal cavity. When the 

 abdomen 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 

 stenosis 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 appendix varies in length. Its average measure- 

 ment in the adult is four inches, the extremes being 

 one inch and six inches. Its position varies, although, 

 as a rule, it is seen to lie behind the end of the ileum 

 and its mesentery, and to point in the direction of the 

 spleen. It frequently also lies behind the caecum. I 

 have seen the appendix so placed with reference to 

 the bowel that it would have been encountered in a 

 right lumbar colotomy. It has found its way down 

 both the right and the left inguinal canals. 



The tip of the process may adhere to a neighbour- 

 ing peritoneal surface, and thus form a " band," be- 

 neath which a piece of small intestine may be 

 strangulated. 



Foreign bodies are very apt to lodge in the 

 appendix, and it is very often found to be occupied by 

 a faecal concretion or calculus. These substances 

 excite inflammation, and, as a result, the appendix 



