FISTULOUS COMMUNICATION BETWEEN THE BLADDER AND INTESTINES. Class 1. —Fistulous communications between the bladder and in testines of a non-malignant character may be caused in three ways : (a) By the passage of foreign bodies from the intestines into the bladder; these have been referred to in a previous section.
(b) By various kinds of non-malignant ulcerations, such as tuber cular or dysenteric, proceeding from the intestine into the bladder, and, more rarely, from the bladder toward the intestines.
(c) By abscesses in relation with the abdominal viscera.
Non-malignant sinuses between the bowels and bladder vary much in degree, and these differences will, to a certain extent, serve as in dications for treatment. The symptoms are usually these : more or less forces and flatus find their way into the bladder, and if the sinus is sufficiently low down, as in the sigmoid flexure or rectum, urine may be passed in considerable quantities, either pure or mixed with faeces, by the anus. As a rule, these symptoms are the more marked when there is diarrhoea or flatulent dyspepsia; in fact some persons only suffer when the bowels are much disturbed. One patient describes his consciousness of the passage of air from the bladder when mictu rition closes with a slight fizzing sound, such as a soda-water bottle gives off. In another instance, the entrance cif air into the bladder
sometimes occasions an acute attack of vesical colic; and cases are recorded where intestinal worms have thus entered the bladder. In the following extract, Dr. W. D. Kingdon, of Exeter, sums up the particulars of a case which was reported and illustrated:" CASE.—The calculus on being carefully divided displayed in its centre a large pin, which satisfactorily accounts for the singular appearances detailed. The poor boy must have swallowed the pin, which, alter traversing the small intestines, formed a lodgment in the appendix vermiformis ; here the irritation caused by it must have given rise to inflammation and adhesion of the process to the exterior of the bladder, and subsequently by ulceration to the passage of the pin into the urinary bladder, where it formed the nucleus of a calculus discov ered after death, though not detected during life. The fistulons com munication with the bladder will likewise account for the voiding of the urine from the anus, the natural orifice being closed by the calcu lus ; and also for the passing of the worms through the urethra on the several occasions mentioned.
The following illustrations are selected from a communication I made upon the subject:"