PERFORATION OF THE URINARY BLADDER BY AN APPENDICEAL ABSCESS
I. S. STONE
Annals of Surgery
Mrs. T., aged fifty years, had the usual symptoms of appen¬ dicitis early in August, 1903. Her condition, in her physician's opinion, was not such as to demand early operation, and she re¬ mained in her bed for several weeks at her home in a small country town during her critical illness. An abscess developed in the right iliac fossa which caused the usual pain with fever. Her bowels were not apparently influenced by the presence of the abscess, nor were the symptoms of peritonitis present.
... r three weeks' illness the patient had dysuria and other signs of cystitis, which finally culminated in a discharge of nearly a pint of pus (during two days) from the bladder. The pain diminished, the fever subsided, and the swelling in the ovarian region began rapidly to disappear. The patient was brought to us, October 24, for examination. Her condition had greatly improved. There was only slight rise of temperature and pulse, and her only complaint was " irritable bladder" and slight tenderness on pressure in the right inguinal region. A mass could be located which showed the site of the former abscess, and we suggested appendectomy in order to prevent future trouble. When the abdomen was opened, we found the appendix with a rather fat mesentery adherent over the right upper cornu of the bladder, and stretching across the right side of the pelvis above the Fallopian tube and broad ligament. There were no adhesions between peritoneal surfaces except at the point where the appen¬ dix and omentum were attached to the pelvic wall as above de¬ scribed. The omentum was evidently of great service in securing the attachment of the appendix to the parietes. When the appen¬ dix was liberated and removed, its distal extremity was found open and in direct contact with the perivesical cellular tissue immediately over the bladder. The bladder was filled with an aqueous solution of methylene blue and was found intact, showing that spontaneous closure had been made. A drainage tube was 265