Peritonitis was apparently not present in any of the cases, the
urinary extravasation having occurred into the cellular tissue
behind the peritoneum.
There are a few recorded cases of uncomplicated wounds of the
ureters. The only well authenticated case in which the ureter
alone was divided is the historic injury of the Archbishop of
Paris, who was wounded during the Revolution of 1848, by a ball
entering the upper part of the lumbar region close to the spine.
Unsuccessful attempts were made to extract the ball, and as there
was no urine in the bladder, but a quantity escaping from the
wound, a diagnosis of divided ureter was made. The Archbishop
died in eighteen hours, and the autopsy showed that the ball had
fractured the transverse process of the 3d lumbar vertebra, and
divided the cauda equina just below its origin; it had then
changed direction and passed up toward the left kidney, dividing
the ureter near the pelvis, and finally lodged in the psoas
muscle.
It occasionally happens that the ureter is wounded in the removal
of uterine, ovarian, or other abdominal tumors. In such event, if
it is impossible to transplant to the bladder, the divided or
torn end should be brought to the surface of the loin or vagina,
and sutured there.
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