MUCOCELE AND DIVERTICULUM OF THE VERMIFORM 

 APPENDIX OF INFLAMMATORY ORIGIN. 



By B. C. Crowell. 

 {From the Biological Laboratory, Bureau of Science, Manila, P. 1.) 



While cystic dilatation of the venniform appendix is in all 

 probability not as rare an occurrence as the literature on the 

 subject would suggest (Kelly, 68 cases), the scant attention 

 accorded it in most text-books on pathology and the paucity of 

 accurate microscopic descriptions which would enable one to form 

 an idea of its pathogenesis amply justify further reports. Fere, 

 in 1887, was the first to apply the term retention cyst, hydrops, 

 or mucocele to that portion of the appendix in which dilatation 

 had occurred, although the condition was first recognized by Vir- 

 chow, who considered his case as one of colloid degeneration of 

 the appendix. 



When the lumen of the appendix becomes occluded at any point, 

 the sequelse in the distal portion depend upon various factors: 



1. If it occur during the course of an acute appendicitis, the 

 remainder of the appendix being also the seat of inflammation, 

 it may result in healing, in perforation, or in gi-adual general 

 diminution of the lumen of the appendix; that is, the ordinary 

 obliterative appendicitis. 



2. If, on the other hand, it occur as the result of a gradually 

 progressing process, a mucocele may result and diverticula may 

 form, the contents being at first mucoid, later clear and watery, 

 and, perhaps, later more viscid and inspissated. For the pro- 

 duction of the cystic dilatation, or mucocele, the necessary factors 

 a priori are: 



(a.) Gradual occlusion of one part. — The cause of this may be 

 a tumor, cicatricial stenosis such as occurs in the healing of 

 ulcers, or angulation produced by peritoneal adhesions, and one 

 case has been reported in which the appendicectomy wound broke 

 down and rapidly healed under antisyphilitic treatment (Lilien- 

 thal). 



(b) Absence of infection icith pyogenic organisms. — If pyo- 

 genic organisms be present at the time of occlusion, or enter 



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