PERFORATION OF APPENDIX BY ROUND WORM
Journal of the American Medical Association
While there have been several reports of cases of per¬ foration of the vermiform appendix by roundworm, these accidents, are yet quite rare. The pathologic de¬ velopment of these cases, of course, varies, but as a rule it is believed-and with good reason-that the worm, finding itself shut in so narrow and blind a canal, bores through in its endeavor to escape. Once in the peri¬ toneal cavity, the worm offers to the peritoneum a two¬ fold insult, mechanical and bactériologie. Outside of its
... Outside of its normal habitat the worm soon dies and is walled off by adhesions. If all goes well, a well-circumscribed abscess surrounds the worm. In the case I have to report the worm failed to get entirely through his own tunnel and probably died as a result of the constriction which took place around his neck, so to speak. In the Museum of the Royal College of Physicians and Surgeons, Lincoln's Inn Fields, Lon¬ don, is shown a roundworm which was strangulated in similar fashion on its ill-advised attempt to pass through the ring of a hook such as is commonly used in fastening women's dresses. The roundworm is at times given to wandering and instances are on record in which it has been found in the stomach, nose, glottis, Eustachian tube, biliary and pancreatic ducts. In rare instances it may perforate the alimentary canal and escape into the peritoneal cav¬ ity and escape from thence by suppurative perforation into the bladder or through the abdominal wall. At times large masses of worms accumulate in the intes¬ tine, causing obstruction and requiring surgical aid. Since the roundworm is cosmopolitan and the major¬ ity of people living in warm climates are infected, it is rather remarkable that more of these cases do not occur. Patient.-A boy, L. M., of West Charleston, aged 12, of slight build, referred by Drs. W. A. McMillan and A. T. Mairs, was suffering from a typical attack of acute appendicitis of three days' duration. There was a well-defined mass in the right lower abdomen. There was a rise of pulse and temper¬ ature, marked leucoeytosis, abdominal rigidity, etc. The his¬ tory of the case presented nothing of special interest. Operation.-An incision of medium length was made over McBurney's point, and, since the abscess was postcecal in loca¬ tion, it was carefully walled off with gauze packs and opened. After opening this abscess and sponging away about three ounces of pus, a whitish slough-like mass was seen to be pro¬ jecting from the side of an inflamed appendix near its base. On opening the appendix it was found that a roundworm was tightly wedged in a tiny perforation, the appendical tissues having a sort of strangle hold about its neck. While the por¬ tion of the worm which had lain in the abscess was partly broken down, the intra-appendieeal part was well preserved and lifelike in appearance. This worm had undoubtedly per¬ forated the appendix, become locked in the wall, and died in situ. The intraperitoneal part of the worm, acting as a foreign body, plus the infection, had resulted in an abscess. The cavity was drained in the usual manner and the boy made an uneventful recovery. Diet.-I. J. Wolf, in the Journal of the Missouri State Med¬ ical Association, states that after all it is not what we eat but what we digest and assimilate that counts. A superabundance of food, which causes the intestines to be filled with decom posed and putrefying matter, and which leads to malassimila¬ tion, is certainly a mistake and not wise and economic nutri¬ tion.