A practical treatise on urinary and renal diseases : including urinary deposits / by William Roberts.

  • Roberts, William, Sir, 1830-1899.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on urinary and renal diseases : including urinary deposits / by William Roberts. Source: Wellcome Collection.

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    in which a congenital anomaly in the anatomical connections of the gland has evidently operated to favour its production. In two cases,* the peritoneum was found reflected over the posterior, as well as the anterior, surface of the kidney, so as to enclose it within a fold of peritoneum, or meso-nephron, which permitted the organ very considerable motion in the abdomen. Mr. Durham examined the body of a woman, aged 34, in which the left kidney was very movable. He found the descending colon much nearer the middle line than usual, and, instead of forming the sigmoid flexure in the left iliac fossa, it turned across the lumbar vertebrae, and passed down into the pelvis on the right side of the sacrum. It was manifest that the mobility of the kidney in this instance depended, in great measure, on the abnormal arrangement of the peritoneum, necessarily associated with the malposition of the colon. So far, therefore, it must be regarded as congenital. When traced from the side of the vertebral column, the peritoneum, instead of passing over the anterior surface of the kidney, only just touched the lower part of its inner border, and then, having formed the descending meso-colon, again touched its outer border. The lesser sac of the peritoneum also, instead of being confined to its ordinary limits, passed so far to the left as to cover the posterior surface of the spleen, and so far downwards as to touch, and be reflected from, the upper border of the kidney. Thus there was no distinct meso- nephron ; but the kidney, instead 01 being supported and kept down by a single layer of peritoneum, was left free to move between and beneath three diverging layers. Upon dissection it was further found, that there was scarcely any fat in the lumbar region, but a quantity of very loose areolar tissue. (Guy's Hosp. Rep. 1860.) The diagnosis of movable kidneys is chiefly important, from the risk of confounding an ailment which is comparatively trifling with some graver disease. In a considerable number of instances, the afifection was long mistaken by the patient and his medical attendants for a tumour within the abdomen ; and * Dr, Priestley's? case—Med. Times and Gaz, , 1857, i. 263 ; and Girard's case—cited bj^ Rayer, 1. c, iii. p. 793.