A case of extroversion of the bladder treated by preliminary narrowing of the gap existing in the pubic symphysis by means of division of the sacro-iliac synchondroses / by G.H. Makins.

  • Makins, George Henry, 1853-1933.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: A case of extroversion of the bladder treated by preliminary narrowing of the gap existing in the pubic symphysis by means of division of the sacro-iliac synchondroses / by G.H. Makins. 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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    failure in one of the essential particulars, that of imme- diate union of the cutaneous margins of the incomplete bladder ; but although not a complete success it admirably illustrates the advantages which the preliminary operation offers, in contracting the area which has to be covered. I think, moreover, that all surgeons who have been called upon to treat cases of this nature must allow that much still remains to be wished for in the methods hitherto at our disposal. The case is as follows : A. J—, set. 5, male, one of seven healthy children. No hereditary history of malformations to be obtained, and the mother does not attempt to assign any cause. The patient first came under the writer’s care, by the kindness of Sir William Mac Cormac, in May, 1883. He was then one year and nine months of age, and his con- dition was as follows : A fairly healthy-looking child with an extroverted bladder. The surface of the bladder is red and granular, in places encrusted with phosphates ; it measures about one and a half inches in diameter both from above downwards and from side to side. There are one or two excoriated patches encrusted with phosphates near the margin; the surrounding skin is otherwise healthy. The penis is small and ill developed, complete epispadias exists, and there is a large pendulous prepuce. The scrotum is perfect, but both testes are undescended, and the inguinal rings are open. On the right side there is a tendency to hernial protrusion of the abdominal contents. There is no umbilicus, but in the situation of the linea alba in its lower half is a shallow groove, bounding the margins of which are the recti abdominales, passing down to the unclosed symphysis, across which there is a gap of about three quarters of an inch. On June 12th, 1883, chloroform having been adminis- tered, a flap of skin two and a half inches wide by five long was raised to thicken, with a view to covering the exposed bladder. Only a single flap was raised, although it was intended to raise a second one for the upper half