Operative gynecology : . and Surg. Reporter, January 19,1889), had a case of recto-vesical fistula following an ischio-rectalabscess five years be-fore. After the abscessdischarged she passedwind and small piecesof fecal matter by theurethra at irregular in-tervals. At the examinationan old extensive scarfrom a pessary wasfound on both sides andin the posterior fornixof the vagina, but nofistula could be foundafter the most care-ful search. At Dr. No-bles suggestion, how-ever, on the followingday hydrogen gas was forced into the rectum, which found its way intothe bladder, and was lighted at t
Operative gynecology : . and Surg. Reporter, January 19,1889), had a case of recto-vesical fistula following an ischio-rectalabscess five years be-fore. After the abscessdischarged she passedwind and small piecesof fecal matter by theurethra at irregular in-tervals. At the examinationan old extensive scarfrom a pessary wasfound on both sides andin the posterior fornixof the vagina, but nofistula could be foundafter the most care-ful search. At Dr. No-bles suggestion, how-ever, on the followingday hydrogen gas was forced into the rectum, which found its way intothe bladder, and was lighted at the end of a catheter introduced into theurethra. Treatment.—The proper line of treatment must depend on the individualcase; no general rules can be laid down. The local affection of the bladdertends to a spontaneous recovery when the canse is removed. If the patientshealth will permit it, a sac which opens into the bladder should, therefore,either be enucleated and the source of the discharge stopped, or evacuated and. Fig. 267.—Pyuria due to Suppurating Adherent Dermoid Cystopening into the Bladder (B). Dec. 17, 1896. (See p. 439.) 442 AFFECTIONS OF THE URETHKA AND BLADDER. drained in some other direction—into the vagina, or by the abdominal wall—so as to give the bladder a chance to recover. In one of the worst cases of pyuria I have ever seen a cure was effected byopening and draining the abscess, which lay in front of the uterus, through theanterior fornix in the vagina. In another case a pelvic abscess on the right side,discharging through the bladder, was relieved by enucleating both tubes andovaries with the uterus, leaving the vaginal portion of the cervix, which wassewed over the fistulous orifice at the base of the broad ligament, so as to divertany discharges into the vagina. The fistula could not be closed by direct sutureon account of the friable inflammatory tissue composing its walls. HEMORRHOIDS. Varicose Bladder.—A hemorrhoidal condition of the bladde
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