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At first this is felt over the entire abdomen, but it is more marked near the navel than elsewhere. After about twenty-four hours it becomes localized in the region of the cecum. The pain is colicky or spasmodic in character, showing that it is due to peristalsis; food of any kind increases the peristalsis; hence the pain becomes more severe after feeding.
The pus finally broke through the adhesions, and produced diffuse peritonitis." It is doubtful if anything but sound tissue could have withstood the strain that was put upon this man's diseased cecum from gas distention. The infection-laden gas could find a way anywhere in diseased tissue and broken continuity.
When the inflammation is confined to that portion of the cecum that gives attachment to the appendix there may be no pain, or the pain may not be intense, and because of this lack of intensity, the patient tolerates abuse in the line of drugging and feeding until an abscess forms, the walls of which surround the appendix which is inflamed and often gangrenous.
From one side of this projects a little wormlike tube, twisted and coiled upon itself, from three to six inches long and of about the size of a slate pencil. It is the shrunken and shriveled remains of a large pouch of the intestine which once opened into the cecum, and was used originally as a sort of second stomach for delaying and digesting the remains of the food.
When the cecum is inflamed it is common for the colon to be loaded; this colon obstruction prevents the onward passage of the contents of the small intestine, and when they cannot free themselves and the peristaltic movements meet with sufficient obstruction to force a halt, the pain and suffering become intense.
"A, ileo-colic artery; B and F, posterior cecal artery; C, appendicular artery; E, appendicular artery for free end; H, artery for basal end of appendix; 1, ascending or right colon; 2, external sacculus of the cecum; 3, appendix; 6, ileum; D, arteries on the dorsal surface of the ileum." Byron Robinson. The reader will see how very much like a blind pouch the cecum is, 2.
The ileum, 6, opens into the cecum, all of the bowel below the opening being cecum, the opening of the appendix, 3, is in the lower part of the cecum. The arterial supply to these parts is great enough to get them into trouble in those people who are imprudent eaters, and it is also great enough to save the parts when diseased if the patient has the proper treatment.
If the child is left alone, given no food, and ice put on the sensitive parts if the temperature is 103 degree F., or hot applications if the temperature is less, the tenderness will probably go away in two or three days; if it does not, an abscess will form and empty into the cecum.
Distention, with the straining of the walls from peristaltic onrushes as described above, and the infection that this part of the alimentary canal is subjected to because of the decomposition of food that is going on to a greater or less extent in all victims of constipation, are the causes of inflammation in the cecum.
When the large intestine is full or distended, as it usually is in cases of chronic constipation, so that nothing can pass out of the cecum this organ becomes a jetty head, so to speak, against which the peristaltic waves from the small intestine break.
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