2
per cent. Ashhurst remarks that he has seen an extraperitoneal
rupture of the anterior wall of the bladder caused by improper
use of instruments, in the case of retention of urine due to the
presence of a tight urethral stricture.
There are a few cases on record in which the bladder has been
ruptured by distention from the accumulation of urine, but the
accident is a rare one, the urethra generally giving way first.
Coats reports two cases of uncomplicated rupture of the bladder.
In neither case was a history of injury obtainable. The first
patient was a maniac; the second had been intoxicated previous to
his admission to the hospital, with symptoms of acute
peritonitis. The diagnosis was not made. The first patient died
in five days and the second in two days after the onset of the
illness. At the autopsies the rent was found to be in both
instances in the posterior wall of the bladder a short distance
from the fundus; the peritoneum was not inflamed, and there was
absolutely no inflammatory reaction in the vesical wound. From
the statistics of Ferraton and Rivington it seems that rupture of
the bladder is more common in intoxicated persons than in
others--a fact that is probably explained by a tendency to
over-distention of the bladder which alcoholic liquors bring
about.
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