Philosophical Transactions/Volume 54/An Account of a Hernia of the Urinary Bladder including a Stone
IX. An Account of a Hernia of the Urinary Bladder including a Stone: By Mr. Percival Pott, Surgeon to St. Bartholomew's Hospital, and F. R. S.
A Healthy boy, about six years old, was suddenly seized with a most acute pain, at the bottom of his belly; during the time the pain lasted he could not discharge a drop of urine, tho' he frequently endeavoured. After about an hour and half, he became perfectly easy on a sudden, and pissed very freely.
A few days after this, a small tumor, about the size of a large pea, was discovered, in the upper part of the spermatic process, just below the groin, As this tumor was perfectly indolent, and gave the child no kind of uneasiness, no notice was taken of it. By flow degrees it descended lower and lower; and as it descended it seemed to increase in size: the boy was observed to make water oftener than usual, but without pain or difficulty. He was looked at by two or three practitioners in the country, who, not knowing what to make of it, advised the letting it alone; at last, in the space of five years, it got to the lower part of the scrotum; and, after it was got thither, it was observed to increase in size much faster than it had done before. The boy was at a great distance from London, and his friends could ill bear the expence of going thither with him; so that another year passed away after the tumor was got into the last-mentioned situation. At last, when he was about thirteen thirteen years old, the swelling becoming troublesome, and the people in the country not caring to meddle with it, he was brought to London.
Two or three gentlemen of the profession, to whom he was showed, took it for a schirrhous testicle, and advised the extirpation of it; to which the child's friends would not consent.
When he was brought to me, I examined him very carefully, and was satisfied that the tumor, (which was now about as big as a middling chesnut) was not formed by the testicle: but, though I was clear that it was not formed by that gland, yet I could not find any testis on that side.
The swelling was still perfectly void of pain; had a stony, incompressible, hardness; was troublesome to the child when at play or using any brisk exercise, but never gave him any uneasiness when he sat, or stood still. It had all the appearance of being dependent from the spermatic process; but the process, tho' it had neither the look nor the feel of being diseased, was yet too large, and too full for a child of that age, and larger and fuller than that of the other side. The perfect equality and smoothness of the tumor, its extreme, incompressibility and its being perfectly free from pain, even when pressed with some force, were the circumstances which induced me to believe that it was not the testicle; but, tho' I was in my own mind satisfied of that, yet I cannot say that I was by any means clear what it was; and all that I could determine, was, that it certainly ought to be removed; as well on account of the trouble it now gave, and its manifest disposition to increase, increase, as that I could not foresee any great hazard that was likely to attend its extirpation.
From the uncertainty in which I was concerning the true nature of the cafe, I determined to act very cautiously. I made an incision thro' the skin and cellular membrane, from the upper part of the scrotum quite down to the lower; by which I discovered a firm, strong, white membraneous cist, or bag, connected loosely with the skin by means of the dartos; I dissected all the anterior part of this cist, quite clean; and found, that, as I traced it upward, it became narrower, and seemed to proceed from the groin: This determined me to try if I could not free the posterior part of it also. In doing this I discovered the testicle, which was much compressed, flat, very small, and lay immediately behind the tumor.
The dissection of the testicle and of the spermatic chord from the bag, and from its neck (which I was obliged to do in order to preserve the testis) took up some time, and gave me some trouble; but, when I had finished it, I found that the cist was dependent from, or continuous with, a membranous tube, or duct, of about the breadth of a large wheat straw, which seemed to pass out from the abdomen, thro' the opening in the oblique muscle, along with the spermatic vessels.
When I had perfectly freed this duct from all connexion, I cut it thro' immediately above the tumor; upon the division of it a quantity of limpid fluid (not less than two ounces) followed, and the mouth of the cist expanding itself discovered a large stone, exactly resembling the calculi found in the urinary bladder; bladder; which stone was closely embraced by the said cist.
As there was not the least appearance of any fluid either in the bag or duct, before it was cut off, this discharge, together with the stone, induced me to suspect that the cafe was a Hernia cistica. In order to be certain, I staid some time; and, when I thought it was probable that some urine was derived into the bladder, I desired the boy to make water; he endeavoured so to do, and a full stream of urine flowed out through the wound in the groin, which put the case beyond all doubt.
I dressed him superficially; he had no bad symptom; his urine all passed out by his wound for a fortnight, or twenty days; at the end of which time, the wound gradually contracted; all the urine came through the urethra; and at the end of a month he was perfectly well.