Transactions of the Philadelphia Academy of Surgery (Volume 9) (Paperback)

Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: Case II.?A domestic, aged 32, was admitted to the Pennsylvania Hospital, August 12, 1905. This patient was sent into the hospital at night as a case of appendicitis and was seen in my absence, by Dr. Francis T. Stewart. Dr. Stewart did not think the case one of appendicitis or one demanding immediate operation. I saw her the next day and could not make up my mind that there was any inflammation of the appendix. She gave a history of repeated attacks of pain in the right side of the abdomen in the appendiceal region, accompanied by vomiting. The pain was more or less fixed, there being no radiation to the back or to the bladder: there were no urinary symptoms. The examination of the urine, however, on the day after admission showed a few red-blood corpuscles and a trace of albumin. Repeated examinations of the urine continued to show red-blood corpuscles. Examination of the abdomen the day after admission showed considerable tenderness over the right kidney. This, however, disappeared and the only tenderness was in the iliac region. A few days later the patient passed both blood and mucus by the bowel and the caecum and sigmoid were quite tender. These symptoms did not persist, as did the microscopic blood in the urine. A differential diagnosis between appendicitis, colitis, renal calculus and ureteral calculus had to be made. With the disappearance of the renal tenderness and of the blood and mucus in the bowel movements, and in view of the absence of the characteristic symptoms of appendicitis, I made a diagnosis of a probable ureteral calculus on August 3Oth, and advised operation. This diagnosis was based on the continued tenderness in the iliac region, the repeated attacks of pain accompanied by slight rise of temperature, and especially the microscopic blood in the urine. Uri...