Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
A tuberculous abscess results from the disintegration and liquefaction
of tuberculous granulation tissue which has undergone caseation. Fluid
and cells from the adjacent blood vessels exude into the cavity, and
lead to variations in the character of its contents. In some cases the
contents consist of a clear amber-coloured fluid, in which are suspended
fragments of caseated tissue; in others, of a white material like
cream-cheese. From the addition of a sufficient number of leucocytes,
the contents may resemble the pus of an ordinary abscess.
The wall of the abscess is lined with tuberculous granulation tissue,
the inner layers of which are undergoing caseation and disintegration,
and present a shreddy appearance; the outer layers consist of
tuberculous tissue which has not yet undergone caseation. The abscess
tends to increase in size by progressive liquefaction of the inner
layers, caseation of the outer layers, and the further invasion of the
surrounding tissues by tubercle bacilli. In this way a tuberculous
abscess is capable of indefinite extension and increase in size until it
reaches a free surface and ruptures externally. The direction in which
it spreads is influenced by the anatomical arrangement of the tissues,
and possibly to some extent by gravity, and the abscess may reach the
surface at a considerable distance from its seat of origin. The best
illustration of this is seen in the psoas abscess, which may originate
in the dorsal vertebræ, extend downwards within the sheath of the psoas
muscle, and finally appear in the thigh.
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