A case of encysted vesical calculus of unusually large size removed by supra-pubic cystotomy / by Walter Rivington.

  • Rivington, Walter, 1835-1897.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A case of encysted vesical calculus of unusually large size removed by supra-pubic cystotomy / by Walter Rivington. 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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    or to break up the calculus. It occurred to me that divi- sion of the calculus might be effected with a chisel and mallet, and I decided to make the attempt. As the calculus below was perfectly smooth and fitted well into the pelvis, I did not think that any injurious bruising of the base of the bladder would result from the concussion of the stone, and I guarded against this by introducing a lithotomy scoop between the calculus and the wall of the pouch, and supporting the calculus during the taps of the mallet by resting the handle of the scoop against the wall of the abdomen and using it as a lever of the first kind. The chisel cut the stone readily enough, and severed it into several large fragments, more or less wedge shaped, which were extracted piecemeal. There was one circumstance which I had not antici- pated, viz. free oozing of blood from the congested mucous membrane of the bladder and its pouch during the manipulations for breaking up, and removing the segments of the calculus. Another event was the escape from the pouch, as soon as the stone had been shifted, of a quantity of most fetid urine. After the removal of the last portion of the calculus the bladder and its pouch were carefully washed out with an antiseptic solution, and all ascertainable fragments were removed. A few chips, however, escaped detection, doubtless having been enve- loped in blood-clot. At the suggestion of Mr. Fenwick I sewed up the wound in the bladder, using fine silk intro- duced with the glover's suture, and a second suture was introduced at the lower angle of the vesical wound. The recti muscles were united with interrupted sutures, and lastly the skin and fascia. In order to guard against urinary infiltration, a drainage-tube was inserted between the lips of the superficial wound, reaching down to the anterior surface of the bladder. A silver tube without a sponge was inserted into the bladder through the perineal wound, the supra-pubic wound was dressed with cotton wool and gauze, and the patient was sent to bed. The operation had lasted an hour and a half. The patient was