Successful case of nephrorraphy for floating kidney. Uncompleted nephrectomy / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Successful case of nephrorraphy for floating kidney. Uncompleted nephrectomy / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    FLOATING KIDNEY. By W. W. keen, M.D., /^^V '^o** PROFESSOR OF SURGERY IN THE WOMAN'S MEDICAL COLLEGE OF PENNSTLTANIA, ~' [Read March 27, 1889.] Miss E. J. F., of Simbury, Pa., aged thirty-five, height four feet eleven inches, weight ninety-two pounds, was sent to the Woman's Hospital on October 4, 1888, by Dr. Mary A. McCay, with a diagnosis of floating kidney. For the following notes I am indebted to Dr. Chapin and Dr. McKee, resi- dent physicians. The patient was delicate as a child; menstruation began at fifteen, and was always painful and irregular. At eighteen years of age she was thrown from a wagon, falling forward with considerable force on her chest and abdomen. Shortly after the fall she suffered with severe pain in the right side and a great deal of distress across the back. Menstruation ceased for six months, and was followed by dropsy and severe illness. There was frequent inclination to vomit, and a great deal of palpitation of the heart. In spite of constant medical attention, she dragged out a miserable existence. About seven years after the fall she noticed a movable tumor in the abdomen, which Dr. McCay believed to be a floating kidney. Present condition.—Appetite and sleep poor; urine 1020, slightly alkaline, twenty-nine ounces in twenty-four hours, no albumin, no sugar. Heart and lungs normal; uterus retroflexed. In the right abdomen was a tumor, about the size of the kidney, which could be freely and easily pushed two or three inches to the left of the middle line back into the right lumbar region, or down into the right iliac fossa. Neither the hilum nor the bloodvessels could be distinctly made out. Percussion over the position of the right kidney showed a tympanitic note, the left renal dulness being distinct and normal. The tumor was evidently not connected with the uterus, ovary, or liver. Operation, October 26, 1888.—Ether was administered. An oblique incision was made at the outer border of the quadratus lumborum four inches long. So soon as the abdominal fat was discovered, search was made for the kidney. The colon was first found, but the kidney was absent from its normal position. Strong pressure being made on the abdominal tumor, it was partly pushed back into position, but could even then only be touched by the finger-tip. On separating the borders of the incision by retractors, it was seen to be the kidney, bare of all fat. In order to replace it entirely, it had to be seized by a volsella. Seven carbolized silk sutures were next introduced by a Hage- dorn needle, four posteriorly and three anteriorly, through the capsule and