Painless calculous pyonephrosis without fever : nephrectomy, recovery / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1901]
Catalogue details

Licence: In copyright

Credit: Painless calculous pyonephrosis without fever : nephrectomy, recovery / 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.

    4/12 (page 4)
    reduced to a mere shred when I divided it at the opera- tion, and cannot now be detected. On the renal side no trace of the orifice of the ureter could be distinguished. The lowest calyces were separate from the rest of the kidney, obstructed and dilated; one bulged between the two terminal divisions of the renal vessels, separating them to the extent of over two inches. The lowest were blocked by a small rough calculus at the infundibulum, and were dilated into a bilocular cyst holding about three drachms of pus. In another loculus, developed from a third dilated calyx, lay, perfectly loose, a fragment of a mulberry calculus, one-third of an inch in diameter. The connective tissue around the two branches of the renal vessels was much condensed by chronic inflammation. Yet there was no sign of inflammation in the fat and other tissues around the kidney. The kidney has been sewn up, so as to appear as it did at the operation, but it has shrunk considerably, so that its main cavity no longer predominates in size over the smaller dilated calices. The infection was probably gonococcal and therefore ascending. It was clear that the calculus in the lower calices blocked them, hence their dilatation, distinct from the general distension of the kidney. The calculus blocked them so firmly, that when the pus emptied out of the kidney as it was laid open the lower calices remained full. The cause of the blockage of the ureter at the pelvis and consequent dilatation of the kidney was not evident. The loose calculus may have formerly obstructed the ureter, and then come loose after the obstruction had been made complete by inflammation and contraction of that duct below the stone. A similar case where the ureter was completely stric- tured but stones were found loose is preserved in the pathological series at the College Museum (No. 3.539A). The kidney was removed by Mr. Meredith from a woman, aged 33, and the disease was traced to an accident nearly five years before the operation. There was a clear his- tory of attacks of pain, but as in my own case, haematuria had never been observed. In the Museum of St. Bartholomew’s Hospital (Series xxviii.. No. 2,375At) is f “ Hydronephrosis of Right Kidney removed by Nephrectomy: .Aberrant Renal Artery,” Trnns. Path. Soc., vol. xlii., p. i8S-