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.

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    closed by first intention; the stitches, however, were not re- moved till a week later. The gum-elastic catheter was re- placed by a new one every two days, and was not withdrawn for two weeks after the injury had been received, and then only for a short time. At the expiration of two weeks, with the absence of all pain and tenderness, opium was omitted. The intestines were relieved by warm water injections on the tenth day, when mild nourishment was ordered. Between the second and third week catheter was permanently withdrawn, and only introduced every four hours for the evacuation of urine. After the third week, patient left his bed. He has re- mained well, working at his trade, and feeling no impediment in his urinary organs. 1876. Alfred Willett. An incision some five to six inches in length, from the umbilicus to the pubes, was made in the mesial line and carried through the parieties. All bleeding points having been secured, the peritoneum was opened, and at once several ounces of dull, brownish fluid, with strong, urinous odor escaped. The intestines were greatly distended and instantly bulged out through the wound. The peritoneum generally was highly injected, and adjacent surfaces. were glued together. Passing my hand into the pelvis, I detected a laceration of the bladder. The coils of gut were only slightly more adherent here than in the abdomen proper ; whilst I satisfied myself there was no protrusion of bowel into the lacerated bladder. The omentum was raised from off the intestines, and so much of the latter as lay in the pelvis were drawn up, laid upon the upper part of the patient’s abdomen, and protected from harm and chill by flannels wrung out of moderately hot water. There was about half a pint of the bloody, urinous fluid in the pelvis, and when this had been sponged away, a rent of the bladder some three and one-half inches in extent was exposed ; it ex- tended diagonally across the fundus, having a direction from before backwards and from right to left. The appearance was that of a nearly straight tear through all the coats of the blad- der, except at its most dependent parts, where it was jagged and uneven. The bladder was flaccid, but, of course, quite empty, and at the site of rupture its walls were fully half an inch in thickness. I brought the torn edges easily in apposition and united them by eight interrupted sutures of fine Chinese silk.