A study of rupture of the bladder : with some experiments bearing upon the closure of the vesical wound / by Alex. W. Stein.

  • Stein, Alexander W., 1841-1897.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: A study of rupture of the bladder : with some experiments bearing upon the closure of the vesical wound / by Alex. W. Stein. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    19/42 (page 19)
    A man, set. 60. Was stamped upon and thrown down a pair of stairs ; brought to the hospital in a state of profound col- lapse. There were marked signs of injury over the abdomen, the least motion of the body caused him to groan and cry out with pain. After he had made several ineffectual attempts to urinate, a catheter was passed and withdrew a quantity of dark bloody urine. The entire appearance of the case led to the diagnosis of rupture of the bladder, but in 10 hours the man died, and the autopsy revealed a laceration of the ilium and no injury to the bladder. Mr. Fleming mentions a very similar case. Important as it is to establish the diagnosis early in all cases, it is even more important to ascertain whether the rupture is intra- or extra-peritoneal. In the early stage of the case when exact knowledge would be most serviceable, such a differential diagnosis is most difficult,'often impossible. In seven or eight instances, the diagnosis of rupture was established by the accidental passage of the catheter through the vesical rent into the abdominal cavity. If, after enter- ing the bladder and removing perhaps a few drops of urine, the catheter is suddenly felt to slip into a secondary cavity, in which its beak is freely movable, and from which a con- siderable quantity of sanguinolent urine escapes, it is certain that the laceration extends into the peritoneal cavity, or that the instrument has entered either a subperitoneal pouch, or if it is situated interiorly, has passed into an ex- traperitoneal circumscribed collection of urine. In some cases it was noted that warm water .injected through the catheter was felt by the patient in the groin and abdomen, and the escape of the fluid ebbed and flowed with the res- piratory movements. As to the significance of peritonitis as an element in diagnosis between intra- and extra-peritoneal ruptures, it is nothing more than strongly suggestive of the former. The development of peritonitis in a given case does not necessarily denote a laceration of the peritoneum, as inflammation of this structure occurs in extraperitoneal