Stage of Disease 5 (Appendicitis)

Operative findings in a 15-year-old boy. On the right side in the picture there is the proximal third of the appendix which is amputated underneath the forceps coming from the right. On the left side in the picture above a sector of the cecum the distal thirds of the appendix are visible; the latter structure is swollen, partially dark-red and greenish discolored and also amputated. The diagnosis is a necrotizing (gangrenous) appendicitis following a mucocele of the appendix. The alvine calculus not visible has led to a distally situated long-standing mucocele (= drainage insufficiency for mucus) and in addition to a necrosis of the bed of the calculus (= site of amputation) following the actual acute appendicitis. Accordingly, the appendix is broken at this level like tinder during traction on it.