328 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



membrane (Figs. 34 and 35). Rupture of the 

 kidney is more often recovered from than is a 

 like lesion of any other of the more commonly 

 injured abdominal viscera. This depends upon its 

 extensive non-peritoneal surface, whereby the extrava- 

 sation of blood and urine that follows the accident is 

 very often entirely extra-peritoneal. The gland may 

 be readily wounded from behind or from the loin, 

 without the peritoneum being injured. When the 

 spine is much bent forwards, the kidney lies in the 

 angle of the bend, at a part where the flexion of the 

 column is the most acute. In. extreme flexion, there- 

 fore, of the spine it may be squeezed between the 

 ilium and the lower ribs. Thus hsematuria is not 

 uncommon after injuries to the back, associated with 

 extreme bending of the spine forwards, as when a 

 heavy weight falls upon the bowed shoulders. 



The kidney is embedded in a large quantity of 

 loose fatty tissue, and suppuration extending in this 

 tissue constitutes a perinephritic abscess. Such an 

 abscess may be either due to disease of the kidney 

 itself, to affections of the adjacent parts (spine, colon, 

 etc.), or to injuries. The pus is at first in front 

 of the quadrat us lumborum, and then usually makes 

 its way through that muscle or through the lumbar 

 fascia. It then presents itself at the outer edge of the 

 erector spinse, having passed between the adjacent 

 borders of the external oblique and latissimus dorsi 

 muscles. It may, however, spread into the iliac 

 fossa, or extend into the pelvis along the loose 

 connective tissue behind the descending colon and 

 rectum, or open into the colon or bladder, or even 

 into the lung. Most rarely of all does it perforate 

 the peritoneum. Renal abscess usually opens upon 

 the non-peritoneal surface of the gland. It may open 

 into the adjacent colon. In one case a renal abscess, 

 due to stone, made its way from the right kidney into 



