Dystocia from congenital cystic kidney of the foetus : with report of a case from the Obstetrical Laboratory of the Johns Hopkins Hospital / by Frank W. Lynch.

  • Lynch, Frank W. (Frank Worthington), 1871-1945.
Date:
[1906]
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Licence: In copyright

Credit: Dystocia from congenital cystic kidney of the foetus : with report of a case from the Obstetrical Laboratory of the Johns Hopkins Hospital / by Frank W. Lynch. 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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    Reprint from SURGERY, GYNECOLOGY AND OBSTETRICS November, 1906, pages 628-637 DYSTOCIA FROM CONGENITAL CYSTIC KIDNEY OE THE FGETUS ‘ With Report op a Case From the Obstetrical Laboratory of the Johns Hopkins Hospital, Professor J. Whitridge Williams, Director By frank W. lynch, Chicago Assistant Professor of Obstetrics, Rush Medical College, Chicago; formerly Associate in Obstetrics, Johns Hopkins University, and Resident Obstetrician of the Johns Hopkins Hospital, Baltimore, Maryland Although congenital cystic kidney of the foetus has long been recog- nized as a cause of dystocia, we find that there are comparatively few cases on record in the literature. Consequently we report the following case, in which was ob- served a twin pregnancy presenting the unique feature of cystic kidney and hydronephrosis of size sufficient to cause an obstacle to the birth of the first child. Case. The patient was a young colored woman, who was brought to the Johns Hopkins Hospital in labor on January 26, 1899. She was 26 years old, and had previously had three spontaneous labors, the oldest child being six years of age, and the youngest three. All the children were perfectly formed, and there had been no complication in the labors or puerperia. She was just about at full term, and the pregnancy had been uneventful up to the last four months, during which time she had been suffering with more or less oedema of the lower extremities. On examination, the pelvis was found to be of normal dimensions, but the uterus was very large, immensely distended, and reached up to within two fingerbreadths of the ensiform cartilage. The back of the child could be made out to the left, and the foetal heart was heard on the left side, just below the umbilicus, and was 160 to the minute. On vaginal examination, the cervix was found completely dilated, the membranes ruptured, and the foot and knee, together with the cord, were project- ing from the cervix. The cord showed a pulse of 162, corresponding closely to the rate made out on abdominal auscultation. Chloroform was at once administered, and both feet were brought down. It was seen that they both were clubbed, and showed six toes on the right foot, while there were seven on the left. As vigor- ous traction failed to accomplish descent, the foetal body was palpated by passing a hand into the uterus, when it was at once found that the foetal abdomen was of enormous size, and appeared to be filled with a cystic tumor mass, which prevented the body of the child from entering the maternal pelvis. Accordingly an incision some 6 or 8 cm. in length was made in the foetal abdo- men by Professor Williams, and a hard, more or less nodular tumor was easily palpated, removal of which was attempted by the fingers. This proved a very difficult operation, inasmuch at the hand soon became cramped, and it was necessary for two to work in turn, until some 470 grams of cystic tissue had been removed and the abdomen became somewhat collapsed. A soft cystic body now presented in the wound, and yielded on puncture about one pint of clear fluid, after which the child was extracted without great difficulty. A second foetus was now found to lie in breech pres- entation, and having ruptured the membranes, delivery was easily accomplished by extraction. This child proved to be a female, normally formed, and of the weight of 2,090 grams The woman made a good recovery, and her tempera- ture during the puerperium was never above 100°. The Foetus. The deformed foetus was 42 cm. in length and 3,800 grams in weight. Projecting through the small posterior fontanel by an opening 2 x 2.5 cm. in diameter was a meningocele 4x3x2 cm. in size. Sixteen teeth were noted in the mouth, not ossified, but distinctly marked off, and cartilaginous in consistency. The right hand had a thumb and five fingers, and extending from the palmar surface of the little finger, an accessory finger was noted. The left hand had thumb and five well-developed fingers. Both feet were clubbed in the varus position and presented six toes on the right and seven on the left foot. The external genitals (male) were normal. Autopsy At the autopsy no abnormalities were noted, save in the liver, kidneys, ureter, and bladder. The liver weighed 150 grams and measured 12 x 8.5 X 3.5 cm. in its various diameters. On its under sur- face, near the left margin, were a number of small, clear, round cysts, the largest of which were 4 cm. in diameter. The left margin was markedly thinned, and contained apparently almost no liver substance, its place being taken by a number of tubular shaped cysts. The gall bladder and ducts appeared normal. On sections of the liver, the parenchymatous tissue showed an unusual amount of connective tissue bands, which appeared to correspond to the site of the biliary canals. Under the microscope this sheath appeared cellular, and con- tained an unusual quantity of ducts, some tortuous, and evidently of new formation, others irregularly dilated into cyst-like cavities. The epithelial lining of these corresponded in character to that of the larger cysts, which was columnar in type. Great numbers of round cells were seen occupying spaces between the hepatic cells. The picture presented accords with that usually noted in similar cases. Inaugural thesis of the Chicago Gynecological Society, June 15, 1906.