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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![I sliall, in concluding this section of my subject, group in tabular form the more important deductions from my anatomico-clinical study. A Table of the Symptoms of Probable and Possible Value in Localizing Perinephritis and Perinephric Abscess. All anterior regions Pain, tenderness, swelling, oedema, and pointing in front and side of abdomen. All posterior regions—Pain, tenderness, swelling, oedema, and pointing in loin. Upper tracts—Pleuritic friction, pleural effusion, empyema, expectoration of pus; dyspnoea; suprarenal involvement; solar plexus in- volvement. (On right side.) Bilateral oedema of legs ; jaun- dice ; fatty stools ; persistent vomiting; rapid emaciation ; as- cites. Middle tracts Albuminuria and casts; suprapubic, scrotal, or vulvar pain or anaesthesia; suppression of urine ; uraemia ; pus in the urine ; oedema of scrotum or varicocele (especially on left side). Lower tracts.—Flexion of hip; pain or anaesthesia of front, inside, or outside of thigli; retraction of testicle ; pain at knee ; scrotal or vulvar pain or anaesthesia, without accompanying albuminuria ; unilateral oedema of legs ; abscess or sinus near Poupart’s liga- ment; constipation (if left side); involvement of chyle receptacle (if right side). In deciding upon tlie point of operation, after a diagnosis of the locality of the abscess has been made, the surgeon must bear in mind the relation of the kidney to the bony landmarks. The upper border of the organ cor- responds very nearly with the space between the eleventh and twelfth dorsal spines. The lower extremity of the kidney is about on the level of the third lumbar spine. The vessels and pelvis of the kidney correspond with the level of the first lumbar sjnne. The right kidney lies a little lower tlian tlie left. The eleventh rib marks with considerable accuracy the upper edge of the kidneys. The riglit kidney has its to]> nearly on a level with tlie lower bonier of that rib, while the left has its upper end about on a level witli the upper margin of tlie same rib. The kidney is about two inches wide, and lies with its inner border quite close to the vertebral bodies. Prognosis A few cases of perinephritis recover without going on to suppuration. The percentage of such results is not obtainable. Gibney gives a good many such instances, of which one was of six months’ dura- tion. AVhen siqipuration occurs the prognosis is good if early evacuation is accomplished spontaneously or by the surgeon’s incision. When the pus is allowed to burrow, prolonged suffering, liectic fever, and often death are the consequence. A fatal issue is certain under such circumstances.](https://iiif.wellcomecollection.org/image/b22379289_0022.jp2/full/800%2C/0/default.jpg)
