. Annals of surgery . prac-tically destroyed andthe right kidney wasdoing a great dealmore than its normalwork. In neither of thesecases was there an impression that the catheter had not gone to position for thenormal kidney and it is easy to see that, had not an X-ray been taken with thecatheters in place, or a pyelogram been done, a lumbar incision would have beenmade, which would have failed to disclose the kidney. The low position demandeda lower abdominal incision. Nephrectomy was advised and accepted and on November j6, the kidney wasremoved through a left similunar line incision, low do
. Annals of surgery . prac-tically destroyed andthe right kidney wasdoing a great dealmore than its normalwork. In neither of thesecases was there an impression that the catheter had not gone to position for thenormal kidney and it is easy to see that, had not an X-ray been taken with thecatheters in place, or a pyelogram been done, a lumbar incision would have beenmade, which would have failed to disclose the kidney. The low position demandeda lower abdominal incision. Nephrectomy was advised and accepted and on November j6, the kidney wasremoved through a left similunar line incision, low down by the extra-peritonealroute. After opening the abdominal wall, the peritoneum was reflected inward,exposing a firmly fixed lobulated mass, tensely fluctuant and lightly adherent tothe surrounding structures, resting upon the bifurcation of the aorta. Thejunction of this vessel with the iliacs was imprinted on its posterior surface aswas found after removal. The vertical incision gave poor exposure and a trans- 66. -Showing catheter curled over ororaontory. SURGERY OF THE ECTOPIC KIDNEY verse incision was made through the abdominal muscles and fascia for about twoinches toward the mid-line. This gave a perfect exposure and alK)wed freedomof manipulation. The vessels came from the left side of the aorta as well asfrom some of the deep pelvic arteries. The ureter was short and ver\- taut andentered the anterior aspect of the kidney into a markedly dilated pelvis. Therewas not the slightest trace of perirenal fat. There were adhesions to the bladder,as well as to the vessels posteriorly. The mass was easily removed. There waspractically no oozing. Wound was closed as usual, cigarette drains placed intothe space from which the kidney was taken. Patient made an uneventful recoveryand left the hospital in sixteen days. C.\SE III.—Mrs. M., age seventy, seen at St. Lukes Hospital, complained offrequent urination. Had always been heahhy. She had no previous trouble ofany sort. Had
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
