Typhlitis

TYPHLITIS, typhlitis (from Greek typhlos-blind), inflammation of the cecum. In former times, T. was often confused with appendicitis, but thanks to the work of Dieulafoy, Hartmann, Mathieu, Klose, Hausmann and others, T. is now considered as a separate nosological form. In the development of T., stagnation of fecal masses in the cecum plays a major role, which can be facilitated by a mobile cecum, significant prolapse of the hepatic flexure of the colon, adhesions between the ascending and transverse colon, bands and generally all those factors that can cause stagnation of intestinal contents. T. can occur as a result of hematogenous infection in typhoid fever, influenza, measles, scarlet fever, septic diseases, etc., as well as by lymphogenous route in diseases of neighboring organs. T. manifests in the same clinical forms as other segmental colitis (see Colitis). The symptomatology of T. in some cases resembles recurrent appendicitis. During periods of remission, patients complain of an unpleasant feeling of pressure and dull pain in the right iliac region, which intensifies with movement and filling of the intestine, which is why they are particularly clearly felt 5-6 hours after eating. Often patients cannot sleep on their left side due to pulling pains that appear in this position and depend on the displacement of the cecum in cases of its significant mobility. During exacerbation, the pain sharply intensifies and can take on a colicky character. On palpation of the right iliac region, diffuse tenderness is noted, corresponding to the cecum and ascending colon. Tension of the abdominal wall muscles and pain points characteristic of appendicitis are absent. The cecum is palpated as a dense cord the thickness of a thumb; when filled with gases above it, a tympanic sound is noted. To determine the mobility of the cecum, the patient must be examined in various positions. During exacerbation of T., a moderate increase in temperature to 37.8-38.5° is often observed for several days. In prolonged forms, constant hyperthermia up to 37.2-37.5° may be observed, which often leads one to think of tuberculosis. The stool in T. can be normal, constipation or diarrhea are common. The number of bowel movements ranges from 3 to 7 times a day. The feces contain large amounts of organic acids. In diarrhea, the feces contain starch, cellulose, a large number of iodophilic bacteria and volatile fatty acids. With significant irritation of the mucosa, a large amount of mucus is noted, and due to the formation of ulcers, blood is also mixed in, and sometimes pus. Due to the multiplication of bacteria in these cases, the feces acquire a putrefactive character and an alkaline reaction, become foul-smelling, contain large amounts of ammonia, indole, phenol. Starch and iodophilic bacteria may be absent, and organic acids remain at low levels. In the urine, protein of various kinds, cylinders, urobilin, bilirubin and a significant amount of volatile fatty acids, indican and phenols are often found. Leukocytosis in T. is normal or rises to insignificant levels. X-ray examination makes it possible to determine the abnormal condition of the cecum and the rate of its emptying. In T. occurring with symptoms of constipation, toxemia develops, manifested by headaches, dizziness, severe weakness and rapid fatigue. Sometimes hypochondria, depression and complete aversion to physical and mental work are observed. Jaundiced discoloration of the sclera, enlargement of the liver may be noted. Patients complain of an unpleasant taste in the mouth, loss of appetite. Gradually, anemia develops, and the amount of hemoglobin decreases particularly sharply. Very often in T., the vermiform appendix is also involved in the process, but its removal does not bring healing to patients. Treatment of T. should be based on the same principles as the treatment of acute and chronic pancolitis. If mechanical causes underlie T., then surgical treatment should be recommended.