In adenitis of the inguino-crural re gion the swelling is found in the external portion of the region if due to a lesion of the gluteal tissues, and in the inner portion of the region if due to a lesion of the anus, perineum, or external geni tals. In both conditions the tumor will have its long axis directed more or less horizontally.
The swelling will be found in the lower portion of the inguino-crural re gion, with the long axis directed more or less vertically, if the lesion causing it is situated on the foot, leg, or lower part of the thigh. This disposition is due to the anatomical relations of the lym phatic vessels and glands, and should be borne in mind. Operation for strangu lated crural (femoral) hernia has been performed for an adenophlegmon of the crural canal.
Etiology.—The lymphatic glands serve as reservoirs on the course of the lym phatic vessels, through which any irri tants or infection must pass.
Cold and overexertion act as local depressants, and thus may indirectly favor the development of adenitis. Gen eral debility has the same effect. The following varieties of adenitis, etiolog ically regarded, arc recognized:— 1. Adenitis by contiguity, resulting from the propagation, by contact, of a neighboring inflammation.
Three cases of suppurating inguinal glands accompanying gonorrhoea in which a bacteriological examination of the pus showed the presence of gono cocci. Pure culture of typical gonococci obtained in one case; on being placed in the urethra of a healthy man this set up a characteristic gonorrhoea. In the two other cases, in which the abscesses opened spontaneously, examination of the pus from the fistulous tract showed the presence of gonococci. and strepto cocci. An attempt to cultivate the cocci on Wertheim's medium, made in one of these cases, failed. Hansteen (Archly f. Berm. and Syph., vol. xxxviii). (See URETHRA.) 2. Adenitis by continuity or following lymphangitis.
3. Adenitis by embolism, due to the transportation of septic or irritating matter, produced in the system or com ing from the outside.
Adenitis of the mesenteric glands may be due to dysentery or to the inflamma tion of Peyer's patches in typhoid fever.
Adenitis occurs in carbuncle, furuncle, vaccination, erysipelas, and eruptive or infectious fevers.
Pathology.—If suppuration does not occur, resolution may take place, or chronic enlargement of the gland may follow hyperplasia of the connective tissue stroma of the gland.
If suppuration does occur the sur rounding connective tissue may, and usually does, suppurate; then the more or less disintegrated gland lies in a sup purating cavity formed by the circum jacent connective tissue.
There are two forms of acute adenitis depending upon the degree of inflamma tion present: 1. Exudative adenitis. In this form the gland is swollen, and it feels hard and elastic. On section it appears red dish brown, like the spleen, with small foci of hTmorrhage, all of which indicate excessive dilatation of the capillaries.
The lymphatic stream is arrested by the dilatation of the cortical lymph-sinuses and their obstruction by fibrin, granular material, and portions of altered white corpuscles. The lymph-follicles are filled with fibrin and accumulated lymph-cells. The stroma of the gland is swollen and infiltrated with cells.
If the section of the gland is scraped, a milky liquid will be obtained, which contains white corpuscles and epithelial cells, the latter showing several nuclei.
2. Suppurative adenitis. In this va riety the gland softens, its tissues become more brittle, hmmorrhagic infiltration centres form that soon change into yel low-, purulent foci. These, at first dis tinctly separate, soon unite, forming an abscess within the fibrous capsule of the gland. Sometimes the periglandular tissue suppurates, while the gland does not.
The glandular abscess and the peri glandular abscess may open externally, each one separately or both simulta neously. The suppurating gland may rupture into the cellular tissue. Occa sionally the gland is hard and elastic; it may be difficult to separate it from its fibrous capsule. The afferent lymphatics are enlarged and thickened. The lymph cells and cortical follicles are few in number and have undergone granulo fatty degeneration.