The Railway Surgeon Volume 21, No. 7 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1915 Excerpt: ...cases. The catheter once in the bladder will drain out the urine and if it is clear will indicate to you that the bladder is not injured but if it is mixed with blood you know you have a more serious problem to deal with. If there is considerable hemorrhage into the bladder and you are satisfied that the wound is extraperitoneal, a suprapubic cystotomy should be done and the bladder packed with sterile gauze to check the hemorrhage and allow the wound to heal. This packing may be left in 2 or 3 days, in addition free perineal drainage must be maintained. In all cases of urethral or bladder injury, free perineal drainage will prove your sheet anchor and will allow recovery in most cases which do not die from shock. Infection will generally follow. If the bladder wound is intraperitoneal--and this may not be easily demonstrated at once--abdominal section should be done with careful suturing of the bladder wall and drainage both above and below. The perineal wound need not be sutured for you will have trouble in keeping it open for drainage for a sufficient length of time.-In one case I have enlarged the perineal wound the second time and still the patient died of septicemia. Irrigation of the bladder with boric acid solution, as soon as the urine has been drawn off will indicate whether the blood in the urine came from the outside of the bladder or whether the hemorrhage is continuous and inside the bladder wall. If the bladder is injured it will be necessary to irrigate once or twice daily with boric acid or potassium permanganate solution. The irrigation should be kept up until all wounds are practically healed and this may mean several weeks. The perineal wound should be packed with iodoform gauze for 2.4 to 36 hours. I do not think efforts at suturing the...