356 SURGICAL APPLIED ANATOMY. [Chap. xvm. 



prostate, that the bladder is tapped when the opera- 

 tion is performed per rectum. The recto-vesical fold 

 of peritoneum is raised, and is carried still farther 

 from the anus when the organ is distended. 



Rupture of bladder. The bladder may be 

 ruptured by violence applied to the anterior abdo- 

 minal wall apart from pelvic fracture or external 

 evidence of injury. Such a rupture cannot, however, 

 happen to the empty bladder, which must be full or 

 distended at the time. It is very rare for the rupture 

 to be on the anterior surface only. As a rule, the 

 tear involves the superior or abdominal surface, and 

 implicates the peritoneum. The injury, therefore, is 

 very fatal (five recoveries out of seventy-eight cases). 

 In some cases of vesical rupture the surgeon has 

 opened the abdomen and has endeavoured to stitch up 

 the rent in the viscus. Such attempts have, however, 

 not as yet been successful, the great difficulty de- 

 pending upon the depth at which the organ is placed 

 when approached from the abdomen, and the impossi- 

 bility, therefore, of entirely closing the tear. The 

 bladder may be torn by fragments of bone in fractures 

 of the pelvis, or by violence applied through the 

 rectum or vagina. A case, for example, is reported 

 (Holmes' " System of Surgery >; ) of a man who fell 

 upon a pointed stake fixed in the earth. The stake 

 passed through the anus, pierced the rectum, and 

 entered the bladder near the prostate. The patient 

 recovered, the wound having been made in the tri- 

 angular area on the fundus of the bladder alluded to 

 above, and therefore outside the peritoneum. The 

 viscus may be ruptured by an accumulation of urine, 

 as seen in cases of congenital closure of the urethra in 

 some infants. In the museum of the Royal College 

 of Surgeons is a preparation of " the bladder of a 

 woman which burst near the entrance of the ureter in 

 consequence of neglected retention of urine." In 



