UROLOGIC LEONARD

TRAUMA BY COMPRESSED

BIEL,

JUAN LAURILLA,

GAS

JR., M.D. M.D.

New York, New York

ABSTRACT - A case of urologic trauma by compressed gas is reported. Emergency treatment consisting of surgical exploration of the peritoneum and cystostomy was required. Subsequently, the stricture which caused the trauma was treated.

The urologic literature is replete with many incredulous cases of the insertion of various items into the urethra, many of which have made their way into the bladder. The senior author has seen a ball point pen in the bladder, and all urologists are fearfully familiar with the accidental breaking of a filiform in the bladder. In addition, there are many tragicomic reports of items used to encircle the penis for various purposes, including, on one occasion at Bellevue Hospital, a bearing made of high-grade steel. The case to be reported is, as far as we can tell, unique. However, since the agent of trauma, namely, compressed gas, is coming into wider use, it is our opinion that this case is worth reporting. Today delicate and precision equipment is shipped in special containers which are sealed using compressed air equipment; in addition, many tools are operated by compressed air. Case Report The patient, a sixty-eight-year-old welder, felt for some time that his urine had not been passing satisfactorily. He said that he had had prostatic trouble from time to time with occasional urgency and hesitancy. However, during the interim periods he was normal, and there was no history of hematuria. Past medical history was noncontributory. On the day of admission while thinking about a solution to his urologic problem, the idea of clearing his tube with his oxyacetylene torch came to him. Accordingly, he placed the tip of the torch in the urethra and turned on either the

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oxygen or the acetylene; he did not remember which, and for the purposes of record we doubt that it is important. This produced immediate pain, both local and abdominal, and the patient was brought to the hospital. When first seen he was in shock, and his blood pressure began to fall rather rapidly and alarmingly as time passed. Intravenous pyelogram showed kidney function bilaterally, and gas was observed under the diaphragm. It was also noted that small bowel occupied the area of the bladder. Laparotomy was performed, and the bladder was noted to be badly torn, with laceration of the mesentery and peritoneum. Bleeding points on the mesentery were ligated; the peritoneal tear was repaired, the bladder reconstituted, and a cystostomy tube left in place. Postoperatively the patient did well and was discharged with the cystostomy tube in place. Approximately six weeks later he was readmitted, and a voiding cystourethrogram showed a small bladder capacity. The suprapubic tube was removed; but on catheterizing the patient to facilitate closure of the suprapubic tract, a stricture approximately 5 cm. from the urethral meatus was noted. This was dilated with filiforms and followers. The patient was discharged after the sinus healed and he was voiding well. When last seen he was voiding well with little residual, and urethral dilation to 26 French was accomplished. 114 East 90th Street New York, New York 10028 (DR. BIEL)

UROLOGY

/ MAY1975

I VOLUMEV,

NUMBER5

Urologic trauma by compressed gas.

A case of urologic trauma by compressed gas is reported. Emergency treatment consisting of surgical exploration of the peritoneum and cystostomy was r...
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