A case of appendicitis in which the appendix became permanently soldered to the bladder, like a third ureter, producing a urinary fecal fistula / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: A case of appendicitis in which the appendix became permanently soldered to the bladder, like a third ureter, producing a urinary fecal fistula / by W.W. 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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    there would be the greatest danger from fecal infection. We deter- mined, therefore, first to divert the fecal stream by a temporary arti- ficial anus in the left side by Maydl’s operation. When this had diverted the fecal stream it was determined to reopen the perineal wound and open the peritoneum, if need be, resecting the coccyx and a part of the sacrum. Second operation, March 18. Left lateral colostomy was done. Before attempting to draw out the bowel we endeavored to see whether we could obtain any information as to the fistula through the abdominal wound, but this was fruitless. A new complication was found in doing the colostomy, viz., a number of strong, tough, slender, fibrous bands which, at several points, passing from one part of the colon to another, made the colon assume the form of loops. (Fig. 2.) The mesocolon was also so short that the colon Fig. 2. Colon thrown into loop by bands. could not be well drawn out of the abdominal cavity to any con- siderable extent. The bowel was then sutured after Bodine’s method (.Medical News, January 9, 1897) for three and one-half centimetres, and the loop secured in the wound by a continuous silk suture. The result of the operation was not altogether satisfactory, as the short mesocolon retracted the spur between the upper and lower bowel so that feces continued to pass into the lower bowel. He went to the seashore on March 31, 1897. On April 8 a second sharp attack of epididymitis occurred on the left side, and the temperature rose as high as 104° F. When he returned, on April 25, he mentioned two facts which immediately arrested my attention : First, that he had repeatedly observed that he could feel fecal matter passing into the bladder before any passed out at the artificial anus, and, second, that lately, on eating some strawberries, he had seen strawberry seeds in the urine before any seeds had escaped from the artificial anus. These