HIsToRY.-since the age of five or six the patient had experienced irregular attacks of lower abdominal discomfort, amounting occasionally to actual pain, and latterly of borborygmi, but no colic. Between the attacks he had been completely free from symptoms. Five or six years ago he had a severe attack of pain in the left iliac fossa, radiating to the right. This was followed by the formation of a swelling in the right lower quadrant which was 'dispersed' by enemata. He was confined to bed for about three weeks with fever and pain localized to the right side. Further attacks occurred ten to thirty minutes after meals for four years, and ended with repeated and copious vomiting; neither this nor food relieved the pain. There were occasional eructations of clear sour fluid accompanied by some nausea. The bowels were not usually regular, and there was a tendency to constipation. During the last three to four months he had lost about 12 lb. in weight. On two occasions he was admitted to hospital with symptoms of acute intestinal obstruction, which were relieved by enemata.
ON ADMIssIoN.-The patient was found t o be tall but of spare build ; his general condition was poor. The abdomen was tender over the right rectus RIULIOGKAPHY.