Cases of rupture of the urinary bladder, with remarks. / By Eben Watson.

  • Watson, Eben.
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Cases of rupture of the urinary bladder, with remarks. / By Eben Watson. Source: Wellcome Collection.

    7/8 page 7
    plicable to such cases as that of M‘Culloch, formerly related;—the only difference being in the position of the rupture, viz.—in the side rather than in the front of the neck of the bladder. Mr Syme, in penning the remark, obviously referred to cases similar to his own, in which no fracture of the pelvis existed; and, in these cir¬ cumstances, the only part of the bladder which could suffer rupture without involving the peritoneum, is the anterior part of its neck. But in cases of fracture of the pelvis, a large portion of the sides, and of the inferior part of the bladder, is liable to rupture, while the peritoneum may not be injured. In regard to treatment as well as to prognosis, cases of rupture of the bladder are divisible into two classes, viz., those within and those without the peritoneal sac. The great feature of treatment in the former class of cases is, incision for the relief of the extrava¬ sation, which is the immediate consequence of such ruptures. In all cases of this kind there will be some external mark of the phe¬ nomenon in question—such mark will be afforded by swelling, as in Mr Syme’s case, or of that combined with crackling, as in the first of the two cases related in this paper. It is extremely unlikely that any such mark should be present if the bladder were ruptured within the peritoneum; for in that case extravasation would be prevented by the peritoneum; and, owing to the nature of the causes which generally operate in the production of such injuries, no apparent phenomenon may indicate rupture of the bladder. A blow on the vesical region of the abdomen may be sufficient to pro¬ duce this lesion, and yet no mark of violence may be visible on the skin; a circumstance which is remarkable in all abdominal injuries. In general concussions of the whole frame, on the other hand, the external marks of injury may be at a considerable distance from the seat of the most important lesion. It is fortunate, however, that in such cases, viz., those in which there is no external mark to direct the surgeon in making his incisions, the situation of the rup¬ ture being most likely within the peritoneum, there is no hope of relief from such practice. The question now naturally occurs. What is the treatment pro¬ per for intra-peritoneal rupture of the bladder ? or. Is there none ? Dr Harrison recommends tapping of the peritoneum from the rec¬ tum ; but the operation has not been tried. Certainly, if such an operation is to be at all successful, that must be the situation of the opening into the peritoneum. There could be no expectation of benefit from paracentesis in the usual place, where it was per¬ formed in two fatal cases of this kind, mentioned by Dr Harrison. This practice seems to me well worth trying in all such cases, in which the bladder is reported to have been much distended at the time of the accident. It can add nothing to the danger of the pa¬ tient, and seems to give him the only chance of life. This opinion is strongly corroborated by an interesting provision of nature which has been found to occur in some of these cases, such as Gibson’s
    digitised image 1
    digitised image 2
    digitised image 3