62 
narrowing is due in the one case (pouch 23 cm. from ileo-caecal valve) 
to a large cystic tumour lying parallel to the longitudinal axis of the 
bowel and attached to that portion of the wall furthest away from 
the attachment of the mesentery. In the other case (pouch 47 cm. 
from ileo-caecal valve) two medium-sized cysts, which have apparently 
coalesced, are lying diagonally across the wall, and directly opposite 
them is another cyst lying lengthwise. In both cases the cysts have 
burrowed or fastened on to the two side walls, drawing and puckering 
them together and resulting in the constriction of the lumen. A few 
medium-sized cysts are attached to the walls of the dilated areas. It 
is probable that these pouches have resulted from the weakening of 
the walls by the damage caused by the cystic tumours and the over- 
distension of the canal: the intestinal contents, being hindered by the 
obstruction, tend to collect, and, through the peristaltic pressure from 
behind, dilatation of the already weakened and inelastic wall ensues. 
Exterior (Plate I, Plate II, fig. 1). 
The walls of the caecum are mottled with bluish-black, slightly 
raised, irregularly shaped areas, especially along the anterior and 
posterior longitudinal muscular bands. These areas are so closely 
approximated as to appear in places as one wide mass; closer 
“r ' em ‘° be a SerieS ° f ^peritoneal cysts covered 
o\er with thickened peritoneum. 
“7 fr °” the ^gitudinal bands are transverse striae 
coloured irr^o- ill , b ^ on ^ these areas are dull ochre- 
• 
striae are outlined h ■ are very P romi nent. Other 
size of small shot, and^re fcw ^ ° Chre - Coloured nodu]es the 
Three dark oval elevated turn 3 ab ° Ve * he SUrfaCC ' 
to 13 mm. in length, and from 2 ° UrS ’ measunn S 6 mm. by 11 mm. 
near the posterior band. The ^ ^ 5 “ height ’ are attached 
surface of the ileum '' Slm ^ ar to the ones on the outer 
the anterior band thl ° k a ° d rigid es P eciaI, v about 
the dark areas can be seen ltl'd V** " P . CaeCUm to ^ ^ 
part of the walls (Plate II fig- s l c ' masses ’ involving the greater 
