[ Reprinted from the Philadelphia Hospital Reports for 1892.~\ 
PERFORATION OF MECKEL’S DIVERTICULUM IN 
A CASE OF TYPHOID FEVER. 
By HENltY W. CATTELL, 'A.M., M.D. / 
The length of the ileum from the ileo-crecal valve to the centre 
of the diverticulum was 1484 centimetres. From the mesenteric 
attachment to the top of the diverticulum was 5.8 centimetres by 3.1 
centimetres across, the transverse diameter of the flattened bowel 
being on the gastric end 2.8 centimetres, and on the valvular end 2.9 
centimetres. This would make the diverticulum proper 3 centime- 
tres to 2.9 centimetres in length and 3.1 centimetres across. There 
was a well-defined ovoidal longitudinal opening opposite the mes- 
enteric attachment from the intestine into the diverticulum of 
about 2 centimetres in length by 1| centimetres in breadth. The 
intestines were firmly matted down together by fibro-plastic lymph 
in the median line, near the symphysis pubis. Two of the perfo- 
rations hereafter to be described were discovered in situ. The 
one in the Meckel’s diverticulum was not discovered by myself 
until the gut had been removed by the resident physician from 
the body, preparatory to washing. The first perforation was 
double and was 42 centimetres from the ileo-cuecal valve, situated 
in a Peyer’s patch, the gut being much thinned out at this point. 
The second one was centimetres farther up, while the third 
was situated deep down in the diverticulum, in the ileo-caecal end, 
the blood-vessels on the serous coat being deeply injected. The 
diverticulum had evidently been in the agglutinated mass, where 
peritonitis had occurred, as lymph was freely attached to its serous 
surface, and a large ulcer was found just beneath the perfora- 
tion in the diverticulum. Numerous ulcers were situated near 
the opening of the diverticulum, one towards the valve being 
large and angry-looking, ovoid in shape, with roughened and un- 
dermined edges. Another ulcer, longitudinal in direction towards 2 
PERFORATION OF DIVERTICULUM IN TYPHOID FEVER. 
the mesenteric attachment, was also in a precarious condition. 
Many of the ulcers were in the transverse diameter, circular and 
crater-like, while most had assumed an elliptical form, though at 
times they were very irregular in outline. They were by no 
means confined to the Peyer’s patches, but were found in any 
part of the intestine. There were ulcers in the caput coli which 
were evidently undergoing cicatrization. In my opinion,, the 
mail was suffering from a relapse of typhoid fever, as numerous 
ulcers were to be found scattered throughout the intestines vary- 
ing from those which had almost entirely healed to those in 
which the perforation had occurred. The specimen was preserved 
for the museum.