CASE OF LODGMENT OF FOREIGN BODY IN THE BLADDER?EXTRACTION BY PERINEAL
INCISION?RECOVERY.
By Kenneth MgLeod, Assistant
Surgeon,
A.M., M.D.,
6th B. L. I.
jSTazie Mattmood Sheik, aged 27, a resident of Hazrabatty in the Jessore District, came to the Jessore Charitable Dispensary, on the 29th of May, 1868, stating that he had got a piece of bamboo into his perinaeum two months before, that it had lodged, and wishing to have it extracted. The man was placed in the position for lithotomy, and his perinaeum. was carefully inspected and examined. No fistula existed, and the only indication of previous injury was a small cicatrix about an inch to the right of the anal orilice. A careful exploration per anum was made without revealing anything unusual, and the man's story was discredited. Further questioning drew attention to the bladder, and a sound was introduced which impinged on what appeared to be a stone, and seemed from the extent to which the instrument passed over its surface to be a large one. The sensation and ring were quite characteristic, and lithotomy was determined upon. On the 9th of June, the patient's condition being favourable, the operation was performed. A semi-lunar incision was made in front of the anal orifice after the method proposed and practised by Sir William Fergusson. This terminated in a lateral incision of the prostate and neck of the bladder. The fore-linger of the left hand was now introduced, and, instead of a stone, a pointed body like a slate-pencil was discovered : its long axis was transverse to that of the bladder. Urine had been voided during the spasmodic stage of chloroforming, and the ends of the foreign body indented the empty bladder on each side. To attempt extraction, while it was in this position, was madness. Owing to the primary incision being central, the finger could be carried well into the viscus. One end of the foreign body was pushed backwards, and the other gradually moved forward by getting the point of the fore-finger beneath and a little behind it. After maneuvering thus for some minutes, the point was got into the wound, and it was laid hold of by a pair of dressing forceps, arid easily removed. On examining the foreign body, it was found to be a pointed bit of bamboo 2j inches long, inch in diameter at the point, and i inch at the base. The three middle fifths were covered with a crust of deposit, and the extremities were smooth.
142 The progress of the
THE INDIAN MEDICAL GAZETTE. case
was
most
satisfactory.
There was
no
haemorrhage and very little oozing. Urine was, from the first, passed entirely per urethram, no fever supervened. He walked about on the 15th, and was discharged well on the 30th. When we enquired more minutely into the history of the case, we got the following interesting particulars from the patient:?
He is by occupation a gliarammie or house-builder. One of the instruments used by gharammies is a bamboo needle called a shamajee, for the purpose of carrying string through a thatched roof, in order to bind it. It is about three feet pointed, and notched near the point where the string is fastened. ?On the day of the accident, patient was descending from the roof of a hut by a ladder, and when he was on the lowest step, his foot slipped and he fell on a sliamajee which had been stuck into the ground point uppermost, and entered his perinaeum at the site of the cicatrice. It broke off at the notch, and the point lodged. He pulled the string out of the wound. There was a small amount of bleeding, but no escape of urine. He walked home assisted by two men. He passed urine frequently with pain. During the following night, there was some suppression, but next day ho urinated freely, and found that small coagula of blood passed. The wound healed up in three or four days without swelling or discharge. He continued to void small quantities of blood for about five days. He subsequently had a purulent discharge from the urethra, a tertian fever, pain, burning sensation in the perinaeum, occasional stoppage of water, and constant uneasiness." Remarks.?It is clear from the history that the fragment of bamboo extracted, penetrated at once and thoroughly into the bladder. Otherwise there must havo been extravasation or at least fistula. The fibres of the bladder must have contracted and obliterated the orifice of entrance, and the foreign body was at the time of extraction in process of becoming the nucleus of a formidable calculus. The case, though, perhaps, not unique, is very precise, and there can be no doubt of the man's statement, which is confirmed by the existence of the cicatrice, and the peculiarities of the fragment which showed on its base the marks of notching. I am aware that foreign bodies of similar description have not unfrequently been removed from the male urethra and bladder; very often from the female. I have myself extracted a full-sized knitting needle from the urethra of a lunatic by pushing at the deep end of it through the rectum. Surgeon-major, H. Baillie, M. d., records a case of extraction of a bit of slate-pencil 2? inches long, by 5 inch in diameter, from the bladder of a boy (Indian Medical Gazette, Volume II, Page 211). I have seen Mr. Syme of Edinburgh take a hair-pin out of the bladder of a female; but, in all such cases, the foreign body has been introduced per urethram. In this case, the introduction was accidental, and through the whole thickness of the perinaeum. There is nothing noteworthy in the operation. Had the expedient of turning failed, I should have divided the fragment in two with a pair of pliers. I think Sir "William Fergusson's plan of operating gave a greater reach and freedom of manipulating than a lateral operation would have done. This is the second case in which I have practised a semilunar central incision terminating in a lateral internal one, and, in the former case also, there was a facility of manipulation and rapidity of recovery, which inclines me to look on the operation favourably. One practical lesson I would urge, namely, examine the bladder with a sound, when there is the least suspicion of any thing in it. I can recollect three cases, when the patients came to be treated for gonorrhcea (dat er beram), which turned out to be stone in the bladder. The case also opens up a most interesting chapter in minor surgery, namely, the surgical effects and the treatment of the thorns, spikes, &c., which so frequently enter the limbs of natives, and sometimes cause most serious secondary effects from the formidable spike of the Phcenioe Sylvestris to the tiny thorns of the Aggemone Mexicana. I commend this object to the attention of the readers of the Indian Medical Gazette.
longt
[July 1,1863.
INCISION?RECOVERY.
By Kenneth MgLeod, Assistant
Surgeon,
A.M., M.D.,
6th B. L. I.
jSTazie Mattmood Sheik, aged 27, a resident of Hazrabatty in the Jessore District, came to the Jessore Charitable Dispensary, on the 29th of May, 1868, stating that he had got a piece of bamboo into his perinaeum two months before, that it had lodged, and wishing to have it extracted. The man was placed in the position for lithotomy, and his perinaeum. was carefully inspected and examined. No fistula existed, and the only indication of previous injury was a small cicatrix about an inch to the right of the anal orilice. A careful exploration per anum was made without revealing anything unusual, and the man's story was discredited. Further questioning drew attention to the bladder, and a sound was introduced which impinged on what appeared to be a stone, and seemed from the extent to which the instrument passed over its surface to be a large one. The sensation and ring were quite characteristic, and lithotomy was determined upon. On the 9th of June, the patient's condition being favourable, the operation was performed. A semi-lunar incision was made in front of the anal orifice after the method proposed and practised by Sir William Fergusson. This terminated in a lateral incision of the prostate and neck of the bladder. The fore-linger of the left hand was now introduced, and, instead of a stone, a pointed body like a slate-pencil was discovered : its long axis was transverse to that of the bladder. Urine had been voided during the spasmodic stage of chloroforming, and the ends of the foreign body indented the empty bladder on each side. To attempt extraction, while it was in this position, was madness. Owing to the primary incision being central, the finger could be carried well into the viscus. One end of the foreign body was pushed backwards, and the other gradually moved forward by getting the point of the fore-finger beneath and a little behind it. After maneuvering thus for some minutes, the point was got into the wound, and it was laid hold of by a pair of dressing forceps, arid easily removed. On examining the foreign body, it was found to be a pointed bit of bamboo 2j inches long, inch in diameter at the point, and i inch at the base. The three middle fifths were covered with a crust of deposit, and the extremities were smooth.
142 The progress of the
THE INDIAN MEDICAL GAZETTE. case
was
most
satisfactory.
There was
no
haemorrhage and very little oozing. Urine was, from the first, passed entirely per urethram, no fever supervened. He walked about on the 15th, and was discharged well on the 30th. When we enquired more minutely into the history of the case, we got the following interesting particulars from the patient:?
He is by occupation a gliarammie or house-builder. One of the instruments used by gharammies is a bamboo needle called a shamajee, for the purpose of carrying string through a thatched roof, in order to bind it. It is about three feet pointed, and notched near the point where the string is fastened. ?On the day of the accident, patient was descending from the roof of a hut by a ladder, and when he was on the lowest step, his foot slipped and he fell on a sliamajee which had been stuck into the ground point uppermost, and entered his perinaeum at the site of the cicatrice. It broke off at the notch, and the point lodged. He pulled the string out of the wound. There was a small amount of bleeding, but no escape of urine. He walked home assisted by two men. He passed urine frequently with pain. During the following night, there was some suppression, but next day ho urinated freely, and found that small coagula of blood passed. The wound healed up in three or four days without swelling or discharge. He continued to void small quantities of blood for about five days. He subsequently had a purulent discharge from the urethra, a tertian fever, pain, burning sensation in the perinaeum, occasional stoppage of water, and constant uneasiness." Remarks.?It is clear from the history that the fragment of bamboo extracted, penetrated at once and thoroughly into the bladder. Otherwise there must havo been extravasation or at least fistula. The fibres of the bladder must have contracted and obliterated the orifice of entrance, and the foreign body was at the time of extraction in process of becoming the nucleus of a formidable calculus. The case, though, perhaps, not unique, is very precise, and there can be no doubt of the man's statement, which is confirmed by the existence of the cicatrice, and the peculiarities of the fragment which showed on its base the marks of notching. I am aware that foreign bodies of similar description have not unfrequently been removed from the male urethra and bladder; very often from the female. I have myself extracted a full-sized knitting needle from the urethra of a lunatic by pushing at the deep end of it through the rectum. Surgeon-major, H. Baillie, M. d., records a case of extraction of a bit of slate-pencil 2? inches long, by 5 inch in diameter, from the bladder of a boy (Indian Medical Gazette, Volume II, Page 211). I have seen Mr. Syme of Edinburgh take a hair-pin out of the bladder of a female; but, in all such cases, the foreign body has been introduced per urethram. In this case, the introduction was accidental, and through the whole thickness of the perinaeum. There is nothing noteworthy in the operation. Had the expedient of turning failed, I should have divided the fragment in two with a pair of pliers. I think Sir "William Fergusson's plan of operating gave a greater reach and freedom of manipulating than a lateral operation would have done. This is the second case in which I have practised a semilunar central incision terminating in a lateral internal one, and, in the former case also, there was a facility of manipulation and rapidity of recovery, which inclines me to look on the operation favourably. One practical lesson I would urge, namely, examine the bladder with a sound, when there is the least suspicion of any thing in it. I can recollect three cases, when the patients came to be treated for gonorrhcea (dat er beram), which turned out to be stone in the bladder. The case also opens up a most interesting chapter in minor surgery, namely, the surgical effects and the treatment of the thorns, spikes, &c., which so frequently enter the limbs of natives, and sometimes cause most serious secondary effects from the formidable spike of the Phcenioe Sylvestris to the tiny thorns of the Aggemone Mexicana. I commend this object to the attention of the readers of the Indian Medical Gazette.
longt
[July 1,1863.
