. Diseases of children. cases to avoid, if possible, surgical interference, in the hope that thebowel may return to a more normal position and the symptoms dis-appear. If the displaced portion of the bowel is fixed in its newposition and produces no alarming symptoms, it should be carefullywatched; if the symptoms persist and are of a sufficiently severe typeto warrant it, surgical interference is indicated. The bowel may be in malposition in a congenital umbilical hernia 9G CONGENITAL MALFORMATIONS ^ which may contain more or less intestine; also in a diaphragmatichernia which may contain coi
. Diseases of children. cases to avoid, if possible, surgical interference, in the hope that thebowel may return to a more normal position and the symptoms dis-appear. If the displaced portion of the bowel is fixed in its newposition and produces no alarming symptoms, it should be carefullywatched; if the symptoms persist and are of a sufficiently severe typeto warrant it, surgical interference is indicated. The bowel may be in malposition in a congenital umbilical hernia 9G CONGENITAL MALFORMATIONS ^ which may contain more or less intestine; also in a diaphragmatichernia which may contain coils pushed through the diaphragm upinto the thorax. EXSTROPHY OF THE BLADDER. In these patients the bladder is situated outside of the abdominalwall, and the malformation is the result of arrested developmentwhich creates a fissure in the abdominal wall. It is by some believedto be the result of the bursting of the allantois, caused by an unusualamount of secretion before the lower aperture for its escape had Fig. 14.—Exstrophy of the bladder and epispadias in a child five months old. Pathological Anatomy.—The anterior part of the abdominal wall isabsent, and there are often other congenital malformations, amongwhich is an absence of union at the symphysis pubis. The fissure mayextend to the urethra with epispadias, fissured scrotum, and unde-cended testes in the male, and open urethra and fissure of the labia andclitoris in the female. Symptoms.—The mucous membrane protrudes through a fissure inthe abdominal wall; it is of normal color, is folded into ridges, andis continuous with the skin of the abdomen. Any increase of intra-abdominal pressure causes a still further protrusion of the mass. Theopenings of the ureters are situated in the lower portion of the urine dribbles continuously, and causes a most annoying irritationof the skin. This, associated w^ith the continual odor of urine, makesall patients who have arrived at an age when they can appr
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