364 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



viscera. This depends upon its extensive non- 

 peritoneal surface, whereby the extravasation of blood 

 and urine that follows the accident is very often 

 entirely extraperitoneaL The gland may he 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, therefore, 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 perinepkritic 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 quadratus lurnborum, 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 blad'Jer, 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 the pyloric end of the stomach, 

 so that a communication was established between 

 those two organs. The perirenal fat is of much 



