A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
Again, a general oozing may often appear a few hours after the
operation, when the patient is warm in bed, apparently from the
substance of the prostate. If raising the breech and the application of
cold fail to arrest it, it may be necessary to plug the wound. This is
done by stuffing it with long strips of lint round the tube. Great care
must be then taken lest the tube become occluded.
3. Infiltration of urine may occur as a result of a too free incision of
the vesical fascia (in adults), and still more frequently of a too small
external wound.
Here it should be noticed that in children it is fortunately of very
little consequence to preserve the integrity of the prostatic sheath of
vesical fascia. In them the prostate is so exceedingly small and
undeveloped, that even the forefinger could not be introduced into the
bladder without a complete section of the prostate. Probably from the
blander nature of their urine, and the greater vitality of their
tissues, this is of less consequence, as it is rarely found that any bad
effects result from this section.
Among other risks we find peritonitis, inflammation of neck of bladder,
inflammation of prostatic plexus of veins, resulting in pyæmia,
suppression of urine, and other kidney complications. For the symptoms
and treatment of these there is no place in a mere manual of surgical
operations.
_Wound of rectum and recto-vesical fistula._--Such wounds were not
uncommon, and in many cases unavoidable, before the days of chloroform,
from the struggles of the patient; now they are comparatively rare, and
should be still rarer. They probably occur in more cases than the
surgeon is aware of, and heal up without his knowledge; we may arrive at
this conclusion from the fact that small wounds are found in
_post-mortem_ examinations of cases in which no such complication has
been thought of.
They occasionally heal without giving any trouble, but, at other times,
as the external wound contracts, a communication forms between rectum
and the urethra, in which the contents are apt to be interchanged in a
most disagreeable manner, flatus passing per urethram, and urine per
rectum.
When it is evidently not going to heal spontaneously, the septum between
the external orifice of the wound and the communication with the gut
should be laid open, as in the operation for fistula _in ano_.
There are certain modifications and varieties in the method of
operating for stone through the perineum, which deserve at least a
brief notice:--
1. _The bilateral operation._--Though he was not the inventor,
Dupuytren's name is justly associated with this operation. The
principle of it is to divide both sides of the prostate equally, so
as to give more room for extraction of a large stone, without the
necessity of much laceration, or the risk of cutting through the
prostatic sheath of fascia.
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