The relations of the pelvic viscera in the infant / by J.W. Ballantyne.

Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: The relations of the pelvic viscera in the infant / by J.W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    marked, the upper part of the bladder will also become distended, and the rugae will disappear both at the upper and lower extremi- ties of the viscus. The important fact with regard to the form of the bladder in the infant is, that the broad end is directed downwards. 21ie Relations of the Bladder.—In the infant the anterior vesical wall is in close contact with the anterior abdominal wall, and there is no intervening pouch of peritoneum. The reflection of the peri- toneum from the anterior abdominal wall on to the posterior bladder wall usually takes place a little below the level of the umbilicus, and from 2 to 3 ctms. above the upper border of the symphysis pubis. In one case in which the bladder was over- distencled, the peritoneum passed to the posterior surface of the bladder about the level of the umbilicus. The anterior surface of the bladder, triangular in shape, is, therefore, entirely uncovered by peritoneum, a fact of great importance to the surgeon who may be contemplating operative interference for stone. Posteriorly the peritoneum passes over the bladder wall, reaching in the male infant to a point immediately below the vesical orifice, and here coming into relation with the small prostate gland, another fact which is of great importance surgically. In the female infant the peritoneum does not descend so low posteriorly, for its point of reflection on to the anterior uterine wall lies above the level of the internal urethral orifice. In the infant the posterior relations of the bladder are less constant than are its anterior relations. In one male infant the bladder was related posteriorly to a loop of sigmoid flexure, and to the commencement of the rectum ; in another the anterior surface of the ctecum was in relation with the posterior vesical wall, but in this case the ctecum lay mesially, and was therefore abnormal in position ; in a male foetus of six months the bladder was related posteriorly to the rectum and to some coils of small intestine; and in yet another premature infant with dropsy, the posterior bladder was in contact with ascitic fluid which lay in the recto-vesical pouch of peritoneum. In the female infants the bladder lay in close relationship with the uterus posteriorly, but in one case there intervened a loop or two of small intestine, which lay in the utero-vesical pouch of peri- toneum, and in this case also the right Fallopian tube lay behind and a little to the right side of the bladder, being also in the utero- vesical pouch. The hypogastric arteries run laterally to the bladder, convergin towards the umbilicus. The Size of the Bladder.—The bladder is relatively small in infants, and this fact is at least one of the causes of the frequency of micturition in infants and young children. Wlien empty the cavity of the organ measures from 2 to 2'5 ctms. in length ; but that the bladder can in exceptional circumstances be greatly distended with urine is proved by one of my cases in whicli its upper wall reached to a point 1 or 2 millimeters above the umbilicus. It is