Clinical pediatrics / by John Lovett Morse.

  • John Lovett Morse
Date:
1926
Catalogue details

Licence: In copyright

Credit: Clinical pediatrics / by John Lovett Morse. Source: Wellcome Collection.

    44/854 (page 44)
    Fistula of the Urachus If the part of the tube between the bladder and the navel does not close, there is, of course, a free connection between the bladder and the navel, and urine runs from the navel. If the tube is closed at the bladder, but open above, there will be a glairy discharge from the opening at the navel. The mucous membrane lining the canal usually protrudes a little. Sometimes, however, it does not, and there is simply a dimple or a small slit where the urachus joins the skin. In rare instances calculi have been found in the canal. Diagnosis.—If the discharge at the navel is watery, the proper tests will show that it is urine. If it is glairy, it may be from either the urachus or a patent MeckePs diverticulum. If it is from the latter, a probe will pass straight into the abdomen; if it is from the urachus, it will pass downward toward the bladder. Treatment.—The treatment is purely surgical. The urachus should be dissected out and, if the canal connects with the bladder, it should be amputated at the bladder. Cyst of the Urachus If the tube closes at both ends, but does not close in the middle, it may become distended by the secretion of the lining membrane and form a tumor in the median line of the abdomen, below the navel and not far from the surface. This tumor will have the characteristics of an unilocu¬ lar, encapsulated, non-inflammatory collection of fluid. It is con¬ ceivable that the tube may close above, but remain open in the middle and at the lower end. If so, it will be filled with urine when the bladder is full and form a tumor which will disappear when the bladder is emptied. Diagnosis and Treatment.—If these tumors are borne in mind, they are easy to recognize and can hardly be mistaken for anything else. The treatment is purely surgical. They should be entirely removed. CONGENITAL MALFORMATIONS OF THE EXTERNAL GENITALS Hypospadias In this malformation, which is due to an arrest of development occurring before the end of the fourth month of fetal life, the opening of the urethra is somewhere in the median line of the lower surface of the penis, instead of at the end of the glans, as normally. The portion of the unclosed urethra beyond is represented by a groove in the median line on the lower surface of the penis. This deformity is described as perineal or scrotal, penile, and balanic, or glandular, according to the location of the opening. It causes no symptoms, unless the opening is constricted, but simply makes the passing of urine inconvenient. If the opening is far back, it may, however, interfere in adult life with procreation. The Treatment is, of course, purely surgical and extremely difficult. It should not be undertaken until the penis is sufficiently developed to make a satisfactory result possible. It seems to be questionable whether it is advisable to interfere, if the opening is in the glans. Undescended Testicles. Cryptorchidism During the fifth and sixth months of fetal life the testicles are in contact with the anterior abdominal wall, near the inner abdominal ring. They enter the inguinal canal in the eighth month and pass into the scro-