The thesis that appendicitis in the majority of cases is a form of closed loop obstruction will be developed in this paper. It will be shown that in 80 per cent of all cases in the series the condition was on an obstructive basis and that in 67 per cent an impacted fecalith was the obstructing mechanism. It will be demonstrated that there is a direct correlation between the presence of a fecalith and subsequent development of obstruction with closed loop formation, eventuating in perforation and peritonitis if the obstruction is not overcome by expulsion of the fecalith or release of the obstruction by other means.As early as 1846 this sequence of events in appendicitis was noted by Volz1 in his monograph. He reported 46 cases in which such a series of events was observed, and he mentioned five other authors who had seen a similar pathologic
BOWERS WF. APPENDICITIS: WITH ESPECIAL REFERENCE TO PATHOGENESIS, BACTERIOLOGY AND HEALING. Arch Surg. 1939;39(3):362–422. doi:10.1001/archsurg.1939.01200150041003
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