A case of extroversion of the bladder / by William Anderson.

  • William Edwin Anderson
Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: A case of extroversion of the bladder / by William Anderson. 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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    friend Mr. H. Milton, of Cairo; and although the result was ultimately disappointing, I propose to describe the procedure in detail in order that the causes of failure may be under- stood. Chloroform having been administered, it was found that with the onset of complete muscular relaxation the extroversion sank back into the pelvic cavity, until the viscuswas represented by a cup-like hollow between the two recti (PI. I, fig. 1). The finger of an assistant was then passed into the bowel and pressed forward in such a way that it could be felt from without, and so formed a guide of some value in the course of the operation. This done, a curved incision was made all around, immediately within the margin of the open bladder and urethra, extending through the mucous membrane and as far into the muscularis as appeared safe. Flaps of these tissues were dissected up for about half an inch from without inwards, one on each side, until it was found that their free margins could be made to meet without tension. After the introduction of an elastic catheter (No. 10) the flaps were joined by a double row of stitches, an inner set of fine catgut, uniting the edges of the mucous membrane, an outer of silk, applied after the manner of Lembert, to the adjacent muscu- laris. The union when complete resulted in the formation of a pyriform vesico-urethral cavity, which was proved by ex- periment to be capable of holding an ounce and a half of milk without leakage (PI. I, figs. 2 and 3). The next step was the dissection from within outwards of two marginal skin-flaps; and after relieving tension by two lateral incisions, carried down to the deep fascia opposite the outer borders of the recti, the edges were brought together over the closed bladder by means of wire sutures and two hare-lip pins. The catheter was tied in and the surface was dressed with iodoform gauze and salicylic wool. The patient, who had borne the prolonged operation exceedingly well, was put to bed in a semi-recumbent posture. All went on favourably during the two following days; the temperature remained normal, the urine escaped freely by the catheter, and the dressings kept dry. On the after- noon of the third day, however, he was seized by an attack of diarrhoea, an epidemic of which had just appeared in the large ward adjacent to his room, and the temperature rose to 100°. No local disturbance was observed, except a diminished drain from the catheter; but the following morning, the fourth, the dressings were found saturated
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