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 liave purposely omitted the details of treatment, because they are not important in studying the clinical history. The symptoms ai'e. however, in my opinion, of great interest, because they localize so distinctly the position of the small abscess. The pain felt early in the disease in the scrotum and testicle, and the paresis of sensation, which soon affected the buttock and the front and outside of tlie thigh, sliow that the pressure was exerted upon the ilio-hypogastric, ilio-inguinal, genito-crural, and external cutaneous nerves. These nerves are branches of the first and second lumbar nerves, which also supply branches to the back. Hence it is evi- dent that the abscess was situated at the level of the first and second lumbar vertebrte. This inference is rendered more conclusive by the ex- istence of albuminuria, which was due to pressure on the renal vein causing congestion of the kidneys. This vein is known to be situated^ on a level with the first lumbar vertebral body. As the abscess approached the surface of the back, pain in the scrotum diminished, and albumen disappeared from the urine, because pressure was decreased. There was no tonic spasm of the psoas, iliacus, or pec- tineus muscles, causing flexion of the hip, as in the case which I shall ])resently describe, because tbe abscess was too high up to press upon the third and fourth lumbar nerves, whose branches supply the muscles men- tioned. It is probable that if the incision had not been made, the abscess by burrowing downwards would finally have given rise to flexion of the thigh upon the pelvis. I do not feel sure of this, because the position of the abscess behind the kidney might have led to spontaneous evacuation through the muscles of the back before tlie quantity of pus had become sufficient to involve the structures opposite and below the inferior end of the kidney.^ These points in surgical anatomy I deem important, because I have not seen them mentioned in connection with perinephritis. They will serve as good guides in the determination of the position of the incision, when the surgeon feels called upon to ex[)lore a suspected perinephric abscess. Cases are rc|)orted where incision or puncture failed to find pus in in- stances whose subsequent history confirmed the diagnosis of abscess. A more careful study of symptoms may hei'eafter enable us to localize tlie pus more exactly. Untreated perinephric abscess, if life is prolonged, usually opens in tbe lumbar region; but the pus may be discharged into the colon, stomach, small intestine, pleural cavity, bronchial tubes, pericardium, or peritoneal 1 See Branne’s Topographical Anatomy, Bellamy’s translation, p. 129. In January and February of this year (1883), after the above paragraphs had been written, this patient was treated by me for a chronic perinephric abscess, situated tliree or four inches below the cicatrix of the first. There was no albuminuria and no scrotal pain ; but flexion of the hip was marked. The abscess was evidently connected with the old seat of disease, for pus was subsequeutlj' evacuated also from the vicinity of the first incision.](https://iiif.wellcomecollection.org/image/b22379289_0011.jp2/full/800%2C/0/default.jpg)
