Communications between the Bladder and the other Abdominal Organs.
There exist a series of other injuries to the bladder, as a result of which openings between and cavities other than that of the genital canal may occur. These other abnormal openings are usually due to dhease of neighboring organs, and in far are largely to be regarded as Nature's mode of curing these maladies. I,Tery frequently they cause no trouble until they have effected a perforation of the bladder; so that vesical symp toms may be the first signs of diseases of other parts, and may indeed continue to the end to be the chief cause of trouble. Thus the bladder may be abnormally attached to an ovary, or it may communicate with the cavity of an ovum that has undergone extra-uterine development, or with the rectum, the large or small intestine, or even with the stomach or the gall-bladder.
Perform ions of the bladder by ovarian cysts are not very uncommon. If only fluid contents pass from cyst to viscus, pus, serum, or colloidal fluid, the urine will only be abnormal so long as the communication exists. If the pressure in the cyst be but small, it will close up again after a time, after having caused at most a teniporary dystiria and a cer tain amount of vesical catarrh. This occurred in liennet's case. It is otherwise if solid matters pass from cyst to bladder, as has occurred with hair, lumps of fat, and teeth. Obrien (1834), Civiale (1860), Robert Lee (1860), Humphrey (1864), and Blackmann (1869), have removed e,on cretions of considerable size from the bladder, the nucleus of which was formed by a tooth. The best recorded case is that of Sentin (Brussels, 1838.) Lithotripsy had been tried upon a woman 58 years old, in whose blad der several calculi had been recognized. Later, lithotomy had been done and two stones extracted, the larger and harder of which was adherent to the upper and inner wall of the bladder. The stone was broken during removal, and contained a true tooth for its core. After the patient's death the inner surface of the hypertrophied bladder was found incrusted with urinary salts. The left ovary was hypertrophied, and had a cavity one inch in diameter in its centre. In this cavity was found a lock of
hair and a bony mass. As it passed towards the bladder, the ovarian cavity narrowed into a e.anal 1 inch long, and 2 to 2.8 inches broad, which opened into the bladder. In this canal lay the hollow crown of a rootless tooth; and both crown and hair and bony mass were incrusted with urin ary salts, showing that the excretion reached the ovarian cavity. The left tube was turned backwards over the left ovarian ligament.
Besides these cases Delpech, Marshall, Larrey, Hamelin, Philipps, Delariviere and Ruge, have found hair that undoubtedly originated from dermoid cysts in the female bladder. In all but Ruge's case bone was found as well, and in many instances fat and other things. L. Mayer and Ulrich have obsermd the evacuation of large quantities of fluid fat from ovarian cystomata into the bladder. In some cases the elimination of hairs, bones, teeth, and fat has lasted for years. Since 1877 more cases of perforation of the bladder by dermoid cysts have been recorded, and have been collected by Pincus and \Iralle. The case that Mlle de scribes is pictured in my atlas from the preparation itself, which I owe to the kindness of Dr. Kuhn of St. Galle. The patient was 29 yeart old, the mother of two children, and was last confined in 1878. Since 1874 she had suffered from hcematuria, and later had shown symptoms of vesical calculus. Dr. Kuhn, dilating the urethra, felt at the left of the posterior bladder wall, a bony substance, extracted it, and recognized a molar tooth. The vesical wall and the peritoneum was injured during the extraction of another tooth, and the patient died of peritonitis.
Extra-uterine fcetal sacs may penetrate the bladder, and set up inflam matory and suppurative processes in its neighborhood. The festal parts possibly pass out through the bladder, but they are more apt to be evacu ated per rectum. Giessler in 1856 could only collect 6 cases of so-called secondary vesical pregnancies. The first case was observed in 1714 by Mersbach. By far the most important and interesting case is that of Josephi of Rostock.