SURGICAL ANOMALIES OF THE GENITO-URINARY SYSTEM.
Wounds of the kidney may be very severe without causing death, and even one entire kidney may be lost without interfering with the functions of life. Marvand, the Surgeon-Major of an Algerian regiment, reports the case of a young Arab woman who had been severely injured in the right lumbar region by a weapon called a "yataghan," an instrument which has only one cutting edge. On withdrawing this instrument the right kidney was extruded, became strangulated between the lips of the wound, and caused considerable hemorrhage. A ligature was put around the base of the organ, and after some weeks the mass separated. The patient continued in good health the whole time, and her urinary secretion was normal. She was discharged in two months completely recovered. Price mentions the case of a groom who was kicked over the kidney by a horse, and eighteen months later died of dropsy.
Postmortem examination showed traces of a line of rupture through the substance of the gland; the preparation was deposited in St.
George's Hospital Museum in London. The case is singular in that this man, with granular degeneration of the kidney, recovered from so extensive a lesion, and, moreover, that he remained in perfect health for over a year with his kidney in a state of destructive disease. Borthwick mentions a dragoon of thirty who was stabbed by a sword-thrust on the left side under the short rib, the sword penetrating the pelvis and wounding the kidney.
There was no hemorrhage from the external wound, nor pain in the spermatic cord or testicle. Under expectant treatment the man recovered. Castellanos mentions a case of recovery from punctured wound of the kidney by a knife that penetrated the tubular and cortical substance, and entered the pelvis of the organ. The case was peculiar in the absence of two symptoms, viz., the escape of urine from the wound, and retraction of the corresponding testicle. Dusenbury reports the case of a corporal in the army who was wounded on April 6, 1865, the bullet entering both the liver and kidney. Though there was injury to both these important organs, there was no impairment of the patient's health, and he recovered.
Bryant reports four cases of wound of the kidney, with recovery.
All of these cases were probably extraperitoneal lacerations or ruptures. Cock found a curious anomaly in a necropsy on the body of a boy of eighteen, who had died after a fall from some height.
There was a compound, transverse rupture of the left kidney, which was twice as large as usual, the ureter also being of abnormal size. Further search showed that the right kidney was rudimentary, and had no vein or artery.
Ward mentions a case of ruptured kidney, caused by a fall of seven feet, the man recovering after appropriate treatment.
Vernon reports a case of serious injury to the kidney, resulting in recovery in nine weeks. The patient fell 40 feet, landing on some rubbish and old iron, and received a wound measuring six inches over the right iliac crest, through which the lower end of the right kidney protruded; a piece of the kidney was lost. The case was remarkable because of the slight amount of hemorrhage.
Nephrorrhaphy is an operation in which a movable or floating kidney is fixed by suture through its capsule, including a portion of kidney-substance, and then through the adjacent lumbar fascia and muscles. The ultimate results of this operation have been most successful.
Nephrolithotomy is an operation for the removal of stone from the kidney. The operation may be a very difficult one, owing to the adhesions and thickening of all the perinephric tissues, or to the small size or remote location of the stone.
There was a recent exhibition in London, in which were shown the results of a number of recent operations on the kidney. There was one-half of a kidney that had been removed on account of a rapidly-growing sarcoma from a young man of nineteen, who had known of the tumor for six months; there was a good recovery, and the man was quite well in eighteen months afterward. Another specimen was a right kidney removed at St. Bartholomew's Hospital. It was much dilated, and only a small amount of the kidney-substance remained. A calculus blocked the ureter at its commencement. The patient was a woman of thirty-one, and made a good recovery. From the Middlesex Hospital was a kidney containing a uric acid calculus which was successfully removed from a man of thirty-five. From the Cancer Hospital at Brompton there were two kidneys which had been removed from a man and a woman respectively, both of whom made a good recovery. From the King's College Hospital there was a kidney with its pelvis enlarged and occupied by a large calculus, and containing little secreting substance, which was removed from a man of forty-nine, who recovered. These are only a few of the examples of this most interesting collection. Large calculi of the kidney are mentioned in Chapter XV.
Rupture of the ureter is a very rare injury. Poland has collected the histories of four cases, one of which ended in recovery after the evacuation by puncture, at intervals, of about two gallons of fluid resembling urine. The other cases terminated in death during the first, fourth, and tenth weeks respectively.
Peritonitis was apparently not present in any of the cases, the urinary extravasation having occurred into the cellular tissue behind the peritoneum.
There are a few recorded cases of uncomplicated wounds of the ureters. The only well authenticated case in which the ureter alone was divided is the historic injury of the Archbishop of Paris, who was wounded during the Revolution of 1848, by a ball entering the upper part of the lumbar region close to the spine.