CASE HISTORY

Admitted to medical ward on 14.2.50 with six months history of colicky abdominal pain and alternating constipation and diarrhoea and also a loss of weight and  dyspnoea on exertion. On examination he was very anaemic (Hb 49%). Barium series revealed a filling defect in the ascending colon just above the caecum. At operation on 14.3.50 an intussuscepted ileocaecal tumour was found, with  secondary deposits in the liver. A right hemicolectomy was done as a palliative measure to improve his anaemia. Postoperatively he was well and when last seen on 25.10.50 he was looking and feeling well. His liver was enlarged but smooth.

PATHOLOGY

The specimen consists of 10cm of terminal ileum, appendix and caecum, with part of the ascending colon measuring 130mm and a segment of mesentery. The anterior wall of the colon and caecum has been removed and the ileum laid open. Surrounding the ileocaecal junction on its distal side is a fungating growth extending along one of the ileocaecal folds and downwards to the appendicular orifice. The outlet of the ileum appears considerably obstructed. On the cut surface the tumour has a gelatinous appearance and it has invaded the caecal wall, but not the wall of the ileum. The lateral wall of the caecum appears thick owing to tangential sectioning. On the medial wall of the ascending colon is a single uninflamed diverticulum. The ileal muscularis is moderately hypertrophied. On the posterior aspect of the specimen there is considerable bloodstaining of the connective tissues at the ileocaecal junction which may have been produced by the intussusception. In the ileal mesentery there is an enlarged gland which in parts appears calcified. In the "mesentery" of the colon several glands are to be seen one of which shows an area of calcification. Below this there is the remains of a gland with an appearance similar to the gelatinous part of the main tumour.