CASE HISTORY

The patient, who was at the time a postgraduate student here, was admitted on 12.5.50  complaining of a dull aching pain in the right lower abdomen, for one week. He had not vomited. In 1933 and again in 1937 he had been successfully treated with emetine for  amoebic dysentery. On examination his temperature was 100F. In the right iliac fossa a  tender sausage-shaped mass could be feld. A provisional diagnosis of appendix abscess was made and he was treated by bed rest only. However, as the mass did not subside, an exploratory laparotomy was performed on 22.5.50. The mass was found to be immediately above the ileocaecal valve and as the nature of the mass could not be determined at operation and carcinoma was suspected, a right hemicolectomy was performed. Post- operative recovery and convalescence were uneventful and when last seen the patient was very well. 

PATHOLOGY

The specimen consists of the posterior half of a right hemicolectomy specimen, comprising 150mm of terminal ileum, the ileo-caecal valve, the caecum and appendix and 170mm of ascending colon. Lying in the ileo-caecal angle and adherent to the termination of the ileum,  the commencement of the colon and the base of the appendix, is a mass which, on its cut surface, has a diameter of 20mm. It is composed mainly of yellowish grey tissue of a fairly loose texture, but embedded in this are six whitish caseous modules, the largest of which, with a diameter of 5mm is lying adjacent to the wall of the ascending colon immediately above the ileo-caecal valve. The mucous membrane of the colon in this region is thickened and inflamed with the maximum change on tis medial wall, where there is some ulceration. It is this part which lies against the mass described above, and to which it is adherent. the remainder of the colon, the caecum, appendix and ileum are entirely normal.