The treatment of traumatic lesions of the kidney : with tables of 155 cases / by William Williams Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of traumatic lesions of the kidney : with tables of 155 cases / by William Williams Keen. 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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    destroyed the man's life. The haemorrhage may extend in several directions. If not extensive, it will form a localized perinephric haematoma, but if the vessels have time to pour out much blood, it may extend upward as far as the diaphragm, downward into the iliac fossa, or in the course of the spermatic vessels to the external ring and along the outside of the ureter to the bladder. It may also push its way between the two layers of the meso- colon and even extend into the meso-rectum. All of this haem- orrhage, it will be observed, is retro-peritoneal. Beside that, however, if there be a rent in the peritoneum, there may be, secondly, distinct intra-peritoneal haemorrhage in addition to retro-peritoneal haemorrhage. The blood also, thirdly, may pass by the ureter into the bladder. If the cortex alone be injured, there will be no hasmaturia, but if the pelvis or a calyx be injured, and, especially if a large vessel be torn, then the blood will reach the bladder in a very short time by the ureter. There are, however, exceptions to this, as, for example, if the ureter be torn away from the kidney, the blood may very easily be poured out into the perinephric tissues, but not reach the bladder, or even if the ureter be almost or quite intact, clots may form in the ureter, which will effectually block it up, and, for a time at least, prevent any haematuria. When the clots are washed out, the haematuria will recommence, only to cease again if a new clot forms. In addition to this, there may be secondary haemorrhage, which, like the primary haemorrhage, sometimes kills the patient. None of the cases of gunshot wounds in my table suffered from this accident. When pure blood passes by the ureter in any large amount, one of the serious complications of wound of the kidney follows, —namely, the accumulation of the blood in the bladder in such quantities as to form firm clots not easily got rid of. The blood may then undergo decomposition, especially if the bladder is diseased, or if a catheter has been used. The resulting cystitis may then infect the original wound or the other kidney and so delay or prevent recovery (I, 17, III, 27). (4) The ureter may be divided by the ball. According to Morris, there are only one certain and one doubtful case of wound