CASE HISTORY

This patient was admitted in July 1951 as an emergency with a subcutaneous perianal abscess. At this time the only physical abnormality was a large tense abscess which was drained and a little tenderness in the right vaginal fornix. She stated that she had had diarrhoea with 2-3 stools a day for 6 weeks. At that time the mantoux test, 1/10,000 was negative. Hb 10.2gm. No parasites were seen in the stools and the pus yielded a profuse growth of anaerobic streptococcus and B coli type of organism. As the ward was being closed for cleaning she was discharged prematurely but remained well. In November 1951 she was readmitted with persistent diarrhoea, lassitude, loss of weight and amenorrhoea. She had a palpable mass, freely mobile, in the right iliac fossa. And a barium meal examination showed a typical string sign of the terminal ileum. Performed a hemi-colectomy upon her on Nov 5th 1951 removing the affected portion of gut, together with the ascending colon, and making the section through healthy ileum. The ileum was  anastomosed to the colon and her subsequent convalescence was uneventful. The anastomosis was an end-to-side one. Patient was seen u to the summer of 1952 when she remained very well and was about to get married.

PATHOLOGY

The specimen consists of the last 18" of the ileum and the first 9" of ascending colon. The proximal few inches of ileum appear healthy. After this the bowel becomes thick-walled with narrowing of the lumen and the mucosa becomes reddened, thickened and irregular, producing the typical "cobble-stone" appearance. In the terminal part of the ileum it is possible to recognize on the cut surface the different layers; on the inside is a pink layer of mucosa, then a very greatly thickened white sub-mucosa, then a brown thin layer of muscularis and one the outside the fatty mesentery. Note that the lesion ceases abruptly at the ileo-caecal valve. The ascending colon shows a few mucosal petechiae. The front has been stripped off the mesentery and a number of enlarged lymph nodes can be seen, but apart from their enlargement no characteristic change is present.