At the hospital his condition was diagnosed and treated
expectantly, but he recovered perfectly and left the hospital
July 10, 1879. He was readmitted on August 4, 1886, over seven
years later, with symptoms of rupture of the bladder, and died on
the 6th. The postmortem showed a cicatrix of the bladder which
had given way and caused the patient's death.
Rupture of the bladder is only likely to happen when the organ is
distended, as when empty it sinks behind the pubic arch and is
thus protected from external injury. The rupture usually occurs
on the posterior wall, involving the peritoneal coat and allowing
extravasation of urine into the peritoneal cavity, a condition
that is almost inevitably fatal unless an operation is performed.
Bartels collected the data of 98 such cases, only four
recovering. When the rent is confined to the anterior wall of the
bladder the urine escapes into the pelvic tissues, and the
prognosis is much more favorable. Bartels collected 54 such
cases, 12 terminating favorably. When celiotomy is performed for
ruptured bladder, in a manner suggested by the elder Gross, the
mortality is much less. Ashhurst collected the reports of 28
cases thus treated, ten of which recovered--a mortality of 64.
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