Urachal cyst simulating appendicular abscess : arrested development of genital tract : with notes on recently reported cases of urachal cysts / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
1909
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Licence: In copyright

Credit: Urachal cyst simulating appendicular abscess : arrested development of genital tract : with notes on recently reported cases of urachal cysts / by Alban Doran. 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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    seems, like King Charles the Second, a most unconscionable time dying. Let them be henceforth relegated to the archives of chronic peritonitis— in other ■words, to their proper place. Cases of Cysts op the Urachus Eecently Eeported. T'wo years ago W. R. Weiser published tables of nearly ninety reported cases of cysts of the urachus. These tables are indispensable for the study of their subject, but they sho'w, as their author admits, that we cannot as yet dra'w from the literature of urachal cysts any sound conclusions such as may be inferred from published series of the ligature of big arteries for aneurysm, or Wertheim’s operation, where at least there ^vas al'ways the aneurysm or the cancerous uterus to begin ■with. Weiser includes Tait’s and Hoffmann’s spurious cases and a considerable number of examples of cystic fistula, t’wo being in his own practice. Weiser’s second case seems an authentic instance of a pure urachal cyst. It bore some relation to my o-wn, as it occurred in a young subject (a girl aged 11) ; it gave rise to an acute attack of abdominal pain, headache, vomiting and fever, and was markedly unsymmetrical. There -was impaired resonance bet’ween the umbilicus and pubes from the left loin to about 2 in. to the right of the median line. When the abdominal incision 'was made the parietal peritoneum was found investing the posterior aspect of a large cyst, which was connected interiorly with a duct running into the bladder, and patulous, let it be noted, to within ^ in. of the vesical cavity. The cyst almost filled the left side of the abdomen below the level of the umbilicus. It contained pus, and had ruptured at one point into the peritoneal cavity. As much of the sac as could be' dissected out without tearing through the abdominal wall was taken away, the cavity left behind was washed out and drained with iodoform gauze, and the patient recovered. Let it be noted that before the operation tuberculous peritonitis was suspected. Whilst Weiser’s ^ own case is well reported, as I have stated above, _ ' Weiser has overlooked a case of cystic fistula reported by Unterberger. A woman had a bad fall during the first month of pregnancy. Acute backward displacement of the uterus occurred, the bladder became distended, and at length urine passed entirely through the umbilicus. Rupture of an adherent ovarian cyst was suspected, but a catheter passed into the umbilicus met another introduced through the urethra. The uterus righted itself, and delivery occurred at the fifth month. Unterberger gives a good summary of cases of urachal fistula and cystic fistula.