CASE HISTORY

Patient admitted complaining of abdominal pain which had started after breakfast 26.6.38. After investigation in the surgical OPD he was sent to the medical ward where they made a diagnosis of tabes dorsalis with possible gastric crisis. His Wassermann was negative. There were no significant CSF findings but the man was an old soldier and had been treated for syphilis ears ago. He was allowed to go home 15.7.38 but came back much worse on the 25th. At this time a provisional diagnosis of pancreatitis was made. He refused operation.

PATHOLOGY

The specimen consists of appendix and lower part of the caecum. The appendix is filled with faecal material and a large faecolith protrudes through a perforation in the wall. The distal inch has become gangrenous and a purulent, haemorrhagic mass has been formed in the serosa and fat around the appendix. Externally the peritoneum is covered with a purulent exudate with congestion of the vessels.