Rupture of the urinary bladder : based on the records of more than 300 cases of the affection / by Walter Rivington.

Rivington, Walter, 1835-1897

Date:: 1884

Credit: Rupture of the urinary bladder : based on the records of more than 300 cases of the affection / by Walter Rivington. Source: Wellcome Collection.

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$and mode of application of tho violence, and the position of weak spots in tlie bladder-wall. 6. In the idiopathic cases rupture is often preceded by some change in the organ itself. Tlius, long-continued obstruction to the passage of urine, whether Irom stricture or enlargement of the prostate gland, occasions hypertrophy of the muscular hbres of the bladder, and the formation of tunicary horniaj, or diver- ticula of the mucous membrane, which protrude through iho muscular fibres, commonly either at or near the summit of the bladder, or posteriorly at the level of the insertion of the ureters. As these pouches are sometimes immediately under the peritoneal tunic, and sometimes unconnected with the serous covering, ruptures due to stricture or hypertrophy of the prostate may ]je either intra-peritoneal or extra-peritoneal. A second condition occasioned by obstruction of the urethra, especially when instru- ni'jnts have been passed, is inflammation of the mucous membrane of the bladder, determined, perhaps, by decomposition of retained urine. The inflammation may end in ulceration, softening, sloughing, or gangrene of some spot in the bladder-wall, often near the summit of the bladder, and then straining to pass water will readily cause rupture. Examples of rupture following soften- ing, sloughing, or gangrene may be found among the cases of rupture from retroversion of the gravid uterus, and one or two of the prostatic cases. A third effect of obstruction is thinning and weakening of the vesical tunics. 7. In. rupture during labour the distended bladder is placed between two forces, the contraction of the abdominal muscles and some part of the cliild's body or the forceps of the medical practi- tioner. The rupture may either be into the peritoneal cavity or into the vagina. Eupture may also occur, sooner or later after the completion of labour, from the injury sustained by the bladder during the process and from subsec^ueut neglect. 8. Each kind of rupture has its own form of rent in the bladder- wail. The ordinary form of uncomplicated rupture from bloAvs, kicks, and falls is a lacerated rent, one inch to three inches, vertical, oblique, or transverse, (a) The more or less vertical rent at the upper part of the posterior wall of the bladder, commencing near the urachus, is the most typical, and results from the application of sudden and equable force to the hypogastric region, but it may also be caused by a fall backwards through the pressure of the abdominal muscles, and by their strong contraction upon a distended bladder; (6) in retroversion of the gravid uterus the opening is either a rent with gangrenous edges, or a sloughy hole or a gangrenous perforation ; (c) in cases of stricture and of reten- tion, where the rupture follows over-distension and strammg, the apeAure is usually a smaU perforation, or a short rent of about half an inch, or a triquetrous opening, or a round hole lined by mucous membrane ; {d) in cases of hypertrophy of the prostate the opening may be smooth and rounded, or a narrow rupture with thinned or sloughy edges.$