Book - Umbilicus (1916) 38

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Cullen TS. Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus. (1916) W. B. Saunders Company, Philadelphia And London.

Umbilicus (1916): 1 Umbilical Region Embryology | 2 Umbilical Region Anatomy | 3 Umbilical New-born Infections | 4 Umbilical Hemorrhage | 5 Umbilicus Granuloma | 6 Omphalomesenteric Duct Remnants | 7 Umbilicus Abnormalities | 8 Meckel's Diverticulum | 9 Intestinal Cysts | 10 Patent Omphalomesenteric Duct 1 | 11 Patent Omphalomesenteric Duct 2 | 12 Bowel Prolapsus at Patent Omphalomesenteric Duct | 13 Abdominal Wall Cysts by Omphalomesenteric Duct Remnants | 14 Omphalomesenteric Vessels Persistence | 15 Umbilical Inflammatory Changes | 16 Subumbilical Space Abscess | 17 Umbilicus Paget's Disease | 18 Umbilicus Infections | 19 Umbilicus Abnormalities 2 | 20 Umbilicus Fecal Fistula | 21 Umbilicus Round Worms | 22 Umbilicus Foreign Substance Escape | 23 Umbilical Tumors | 24 Umbilicus Adenomyoma | 25 Umbilicus Carcinoma | 26 Umbilicus Sarcoma | 27 Umbilical Hernia | 28 The Urachus | 29 Congenital Patent Urachus | 30 Urachus Remnants | 31 Urachal Remnants Producing Tumors | 32 Large Urachal Cysts | 33 Anterior Abdominal Wall Abscesses | 34 Urachal Cavities | 35 Umbilicus Acquired Urinary Fistula | 36 Urachal Concretions and Urinary Calculi | 37 Urachus Malignant Changes | 38 Urachus Bleeding into the Bladder | 39 Patent Urachus Tuberculosis | Figures
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Chapter XXXVIII. Bleeding from the Urachus into the Bladder

The literature on this subject is a negligible quantity. W. Ramsay Smith reports a case which, although somewhat obscure, may be mentioned here.

  • Smith, W. Ramsay: Obstet. Trans., Edinburgh, 1892-93, xviii, 53.


The patient, a female infant, was born August 3d. The labor was short, and the child brought away with forceps. The cord appeared to be normal. On the second night, August 5th, a large quantity of bright-red blood was noticed on the infant's binder. It appeared on that night only, and the nurse noticed that it was coming not from the cord,- but from the umbilicus at the side of the cord. Two days later (August 7th) the child had an attack of diarrhea, and there was a good deal of blood in the stools, and it was noticed that this blood was coming from the urethra. On August 8th the bleeding was very severe, there being over two teaspoonfuls at a time. The blood always appeared when the bowels moved, but it came from the urethra. The diarrhea ceased, and the bleeding stopped on August 9th. Smith thought that the bleeding took place from the hypogastrics, and escaped to the bladder along the urachus. Ballantyne felt somewhat reluctant to accept this explanation, but said that, under the circumstances, it was difficult to suggest any that was more satisfactory.

A few years ago, while discussing diseases of the umbilical region with Dr. Edward Reynolds, of Boston, he mentioned the fact that on several occasions he had noted bleeding from the urachus into the bladder. Later I wrote asking him kindly to furnish me with the data he had bearing on the subject. His reply was as follows :

"With regard to my recent hematuric case, the patient was a physician about thirty-five years old, from whom I removed the appendix about two years ago. She came to me on the seventh of February, saying that, after very hard and long automobiling over rough country roads a few days before, she had been seized by a sudden urgent desire to urinate, and had passed a quantity of bloody urine. Since then urination had been normal, but the urine was slightly blood-stained. She informed me that she had noticed that the first part of the urine was clear and that the blood came with the last few drops. When I first looked into her bladder the small amount of urine was clear (she had just emptied it). I inspected the trigonum and fundus of a normal bladder carefully in the knee-chest position, and, on turning the point of the cystoscope forward, found that in the interval the urine had become distinctly pink. I then emptied the bladder thoroughly with the evacuator, and saw a small stream of blood flowing from the orifice of the urachus. The patient has written me since that the hematuria stopped within forty-eight hours after her visit to me, and that there was no recurrence. I told her that I thought there was no other treatment than the removal of the urachus; that I should not advise that unless the symptoms were persistent; that I should advise it if the hematuria were recurrent. I asked her to keep me informed of her progress, and I think that she will do so.
This is not my first case of the kind. A good many years ago, when I was doing a large out-patient clinic and making a great many cystoscopic examinations, I saw a number of cases, I should guess from half a dozen to a dozen, in which minor vesical symptoms seemed to be associated with a reddened, eroded condition of the vesical mucous membrane immediately about a small orifice in the upper and anterior part of the bladder, which, after some study, I grew to consider as the orifice of a patent urachus, and which, on close inspection, I could recognize in a considerable proportion of bladders in which it was not making trouble. I believe that this slight anomaly is very common, and that it is a not unimportant lurking-place for bacteria in infected bladders. In at least two cases in these old days I saw bleeding from this orifice; I think in more than that number, but the conditions of the clinic made careful record keeping very difficult. I should say that the hematuria was transient but recurrent. I do not know the ultimate outcome. The patients in that clinic were all of a class which it is difficult to follow up afterward."


Dr. Reynolds' observation clearly demonstrates that in some cases blood does escape from the persistent urachus into the bladder. His suggestion that the urachal opening is probably the lurking-place of bladder infections is fully borne out by the cystitis frequently noted where a partially patent urachus exists.


Umbilicus (1916): 1 Umbilical Region Embryology | 2 Umbilical Region Anatomy | 3 Umbilical New-born Infections | 4 Umbilical Hemorrhage | 5 Umbilicus Granuloma | 6 Omphalomesenteric Duct Remnants | 7 Umbilicus Abnormalities | 8 Meckel's Diverticulum | 9 Intestinal Cysts | 10 Patent Omphalomesenteric Duct 1 | 11 Patent Omphalomesenteric Duct 2 | 12 Bowel Prolapsus at Patent Omphalomesenteric Duct | 13 Abdominal Wall Cysts by Omphalomesenteric Duct Remnants | 14 Omphalomesenteric Vessels Persistence | 15 Umbilical Inflammatory Changes | 16 Subumbilical Space Abscess | 17 Umbilicus Paget's Disease | 18 Umbilicus Infections | 19 Umbilicus Abnormalities 2 | 20 Umbilicus Fecal Fistula | 21 Umbilicus Round Worms | 22 Umbilicus Foreign Substance Escape | 23 Umbilical Tumors | 24 Umbilicus Adenomyoma | 25 Umbilicus Carcinoma | 26 Umbilicus Sarcoma | 27 Umbilical Hernia | 28 The Urachus | 29 Congenital Patent Urachus | 30 Urachus Remnants | 31 Urachal Remnants Producing Tumors | 32 Large Urachal Cysts | 33 Anterior Abdominal Wall Abscesses | 34 Urachal Cavities | 35 Umbilicus Acquired Urinary Fistula | 36 Urachal Concretions and Urinary Calculi | 37 Urachus Malignant Changes | 38 Urachus Bleeding into the Bladder | 39 Patent Urachus Tuberculosis | Figures

Reference

Cullen TS. Embryology, anatomy, and diseases of the umbilicus together with diseases of the urachus. (1916) W. B. Saunders Company, Philadelphia And London.

Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)

Cite this page: Hill, M.A. (2019, September 18) Embryology Book - Umbilicus (1916) 38. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_Umbilicus_(1916)_38

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