The relations of the pelvic viscera in the infant / by J.W. Ballantyne.

Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: The relations of the pelvic viscera in the infant / by J.W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    mesial section of the pelvis (vide Plate, Fig. 1), almost entirely above the pelvic brim, only a small part of the lower and posterior segment lying below that plane. In the case of a full-time male infant (Fig. 2), in which the bladder was very greatly distended with urine, a still smaller part of the lower end of the viscus lay below the pelvic brim, in the plane of which lay the vesical openings of the ureters. In this specimen the section passes slightly to the right of the middle line, for it cuts through the right ureter at its point of entrance into the bladder. In the case of another full- time male infant (Fig. 3), in which the bladder was only partially filled with urine, the same relation of that viscus to the plane of the brim was found to exist. In this case the whole bladder cavity is not laid open, as the section was made considerably to the right of the middle line of the body. In the cases of three full-time female infants (Fig. 4), in all of which the bladder was empty, an almost inappreciable part of the vesical cavity lay below the plane of the brim. Symington states that fully half the bladder in the infant lies within the cavity of the true pelvis and below the plane of the brim. The specimens above mentioned do not show this disposition of the bladder, but in three of the cases (two male and one female) there existed a circumstance which may serve to explain the difference in position of the bladder. Tliis circumstance consisted in the presence of a loop of the lower end of the descending colon or of the upper end of the sigmoid flexure within the pelvic cavity, lying in the female infant in the right part of the utero-rectal pouch, and in the male infants in the recto-vesical pouch. In the other female infants the bladder was empty, and was not therefore distended at its lower end; and it must not be forgotten that in them there lay part of the ^Uerus within the pelvic brim. In the case wliich Symington figures in his Atlas (p. 68), in which half the bladder lay in the pelvis, the infant was a male, therefore there was no uterus to fill up the brim, the bladder also was distended, and bulged backwards towards the sacrum; and further, there was no loop of sigmoid flexure in the pelvis, the posterior vesical wall lying in contact with the rectum, and the recto-vesical pouch being empty. If the pelvis contain in addition to the rectum a twist of sigmoid flexure, and more espe- cially if the subject be a female, it is difficult to see where room can be found within the pelvis for fully half the bladder. The arrangement of sigmoid flexure to which I have above alluded is, I believe, a very common one in the infant, and I find that Jacobi {Archives of Pediatrics, 1888, p. 204) makes tlie statement that the sigmoid flexure is bent upon itself several times in the narrow pelvis of the infant. In the case of male infants in whom no loop of sigmoid flexure exists in the pelvis, and in which the bladder is distended, that organ may be found lying to some extent below the plane of the brim; but in the female infant, where the uterus partly fills up the brim, and in male infants, where the sigmoid