The clinical history and exact localization of perinephric abscesses / by John B. Roberts.
- John Bingham Roberts
- Date:
- 1883
Licence: Public Domain Mark
Credit: The clinical history and exact localization of perinephric abscesses / by John B. Roberts. 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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![cavity ; or the abscess may open upon the surface in the liypochondrium, below Poupart’s ligament, upon the buttock through the sciatic notch, or by perforating the ilium, or discharge into the pelvis of the kidney, the bladder, vagina, or urethra. The pus may find its way into the sub-iliac bursa, and, by the communication that often exists between this sac and the hip-joint, even enter the joint itself. It may burrow into the scrotum. The pus may amount to three or four pints, and may, especially in consecutive abscesses, be thin, ichorous, and mixed with urine. It may be offensive and fecal in odour, even when there is reason to believe that no intestinal fistule communicates with the pus cavity. In primitive perinephric abscess the pus is thick and odourless, and perhaiis contains shreds of connective tissue. Trousseau has observed^ emphysema under the integu- ment of the back from an opening between the gut and the abscess. The large amounts of pus only occur when delay in operating has allowed ex- tensive suppuration. Bowditch^ believes in the frequent occurrence of thoracic complications from contiguity with perinephric abscesses. He describes two cases, in which he was consulted for lung disease, that were found to be perinephric abscesses opening through the lung. The following case illustrates the course of the disease when not treated by prompt surgical measures :— Case II. Probable Perinephric Abscess following Gonorrhoea; Con- dition not suspected; Death %vith Septiccemic Si/inptonis This history, which dates back a number of years, is a humiliating one, for, though the patient was seen by myself and several other medical men, the ])0ssible existence of perinephric abscess was not suggested until death had oc- curred. When subsequently thinking over the circumstances, I became convinced that the purulent collection, for w'hich we had searched in vain in the pelvic and anterior abdominal regions, should have been looked for in the lumbar region, 'riiougli proof was then unattainable, I believed, and still believe, the posthumous diagnosis ])robably correct. The patient, on account of gonorrhoea, had retention of urine, wdiich required catheterization. Subsequently orchitis with scrotal abscess oc- curred, and about the same time, or ])erhaps a little previously, a small abscess on the outer aspect of the left thigh appeared. Both these collec- tions of pus were evacuated by incision. During the maturation and cure of these abscesses, the. right hip became somewhat flexed. When I saw him after an absence of some we(;ks, I found the thigh firmly flexed, and the jiatient weak, nervous, and hysterical, afraid of any examination, and continually desiring morphia or ether. He could not move his thigh be- cause of j)ain, nor would he allow it to be extended. It was thought pro- bable that the position of tlie idght limb was originally due to the patient liaving assumed this posture to keep the scrotum and left thigh free from pressure of the bed-clothes, and that the voluntary disuse of the joint during a aeries of weeks had induced in his irritable and nervous condition a hysterical contraction. Ether was administered, and the hip forcibly ' Clinical Medicine.](https://iiif.wellcomecollection.org/image/b22379289_0012.jp2/full/800%2C/0/default.jpg)
