A CASE OF TYPHLOENTERITIS 
(Ulceration of the Ccecum.) 
Operation: LAPAROTOMY, INTESTINAL SUTURE. 
RECOVERY. 
BY 
WALTER BLA, M. I2>., 
VISITING PHYSICIAN TO THE CAMBRIDGE HOSPITAL. 
4 V A JU V 
Reprinted from the Boston Medical and Surgical-ftntvndl of 
February 6, i8qo. 
BOSTON: 
DAMRELL & UPHAM, Publishers, 
283 Washington Street. 
[890. S. J. PARKHILL & CO., PRINTERS 
BOSTON A CASE OF TYPHLOENTERITIS. 
Ulceration of the Ccecum; Operation; Laparot- 
omy; Intestinal Suture; Recovery.1 
BY WALTER ELA, M.D., 
Visiting Physician to the Cambridge Hospital. 
T. K., a boy of seven years, entered the Cambridge 
Hospital on the evening of December 5, 1889, with a 
temperature of 103.5°, pulse 138 and respiration 22. 
He was seen by me the following morning, when his 
countenance was anxious and pinched, tongue covered 
with a thick, white fur, knees drawn up, abdomen 
much distended, and so tender everywhere that no 
examination could be made. 
Before etherizing him it was deemed best to have 
his parents present, and to obtain the previous history 
of the case from his former attendant, Dr. F. W. 
Taylor, who said that a week before the boy was 
taken with abdominal pain. After a dose of castor 
oil he had several loose dejections. When seen for 
the first time three days later, his legs were drawn up ; 
he complained of pain in the right iliac region, where 
there was dulness on percussion, and resistance on 
palpation, and extreme tenderness in the right lumbar 
region. No nausea nor vomiting since the first day. 
During the week the temperature had ranged from 
101° to 104° and the pulse from 120 to 130. 
In the afternoon of the day I first saw him, an ex- 
amination under ether showed the abdomen distended 
and tympanitic, except in the right iliac and lumbar 
regions where there was dulness and a marked feel- 
1 Read before the Cambridge Medical Improvement Society, Decem- 
ber 30, 1889. 3 
Rather than establish an artificial anus in the right 
groin, owing to the necessity of drainage-tubes, and 
for odier reasons, the intestinal ulceration was closed 
by fourteen fine silk sutures introduced after the Lem- 
bert method, the outer ones going well beyond the 
rent. The edges of the ulceration were left intact. 
The sutured intestine was returned to the abdominal 
cavity which was thoroughly irrigated with plain water 
at a temperature of 105°. Cat-gut ligatures were 
applied to two bleeding points in the abdominal inci- 
sion, and the ends cut closely off. The abdomen was 
again irrigated, as before, until clear water flowed. A 
long, fenestrated glass tube was passed into the pelvic 
basin, and a fenestrated rubber tube was placed directly 
downwards whence the pus originally came, and this 
was fastened to the skin. Five silk sutures passed 
through the skin, muscles and peritoneum approxi- 
mated the edges of the wound. All fluid was removed 
from the peritoneal cavity that was possible. Antisep- 
tic precautions were observed during the operation, 
which lasted two and a quarter hours, and the wound 
was dressed with iodoform and corrosive sublimate 
gauze. An enema of half an ounce of brandy was 
not retained, so he was given wine whey by the 
mouth. Heaters in bed. 
During the night he slept four or five hours, and 
the next morning two drachms of yellow pus were 
removed from the tubes by suction with a syringe. 
Diet: peptonized milk and wine whey every hour, 
alternating. Enemata of peptonized milk were not 
retained. Wound dressed twice daily, removing by 
suction each time a small quantity of pus. Com- 
plained of slight pain in right flank. Temperature 
fell 3° after the operation ; pulse remained as before ; 
respiration fifty. 
On December 8th was brighter after sleep from an 4 
opiate. Glass tube was filled with clear serum. Pus 
and small coagula removed from rubber tube by suc- 
tion. Abdomen not distended. Comfortable day. 
Takes nourishment well. The next morning he awoke 
refreshed, after a good sleep. He complained of some 
pain, perspired freely. Temperature 100° ; pulse 94; 
respiration 25. 
December 10th. Had two natural dejections in the 
night, the first one of a reddish color; the first one since 
taking the castor oil and four days after the operation. 
Quite a comfortable day. Only a small quantity of 
pus removed by suction from the rubber tube, none 
from the glass tube, which was removed to-day. Sut- 
ures cut through. Gaping wound approximated by 
adhesive plaster. 
December 11 th. Splendid night’s sleep, comfortable 
day. Next day was hungry ; had but little pain ; slept 
without an opiate; tongue cleaning; natural dejection. 
December 15th. Has natural dejections daily. Up 
to this date the wound has been dressed twice daily, 
but now once daily, as there is so little discharge. 
Sleeps well. Appetite good. He continues to im- 
prove day by day. 
December 20th. Rubber tube was removed, as 
lumen was obstructed by granulations. 
With the exception of the 22d when his tempera- 
ture was 101° and his pulse 130, he steadily conva- 
lesced, feeling happy and well. 
January 5, 1890. A month after entrance. Sat 
up in chair all day. Appetite good; temperature nor- 
mal ; bowels act naturally ; has house diet. 
January 17th. Six weeks after entrance. Wound 
is healed. He has gained considerable flesh. Dis- 
charged strong and well. 
January 25th. Visited at his home. Continues 
perfectly well. Goes to school; and his mother says 
he is as well as ever. 5 
This case is an instructive one, as showing that the 
abscess was not due to an appendicitis, and that the 
healthy appendix, though adherent, was not the pri- 
mary cause of the disturbance. It shows that all cases 
of iliac abscess are not necessarily appendicitis. The 
lesson to be drawn from this case is to look for the 
possible ulcer of the intestine, as well as to the condi- 
tion of the appendix, as, if this is overlooked, though 
the patient recovers, the result may be an artificial 
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