File:Surgery, its principles and practice (1906) (14586802599).jpg

Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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d be openedthrough the rectum underanesthesia after wide dila-tation of the sphincter sothat the point of fluctua-tion can be well reached orthrough the curved trans-verse perineal incision ofDittel and Zuckerkandl(Fig. 347). This, however, is a formidable operation and should not be selected, if the simplermethod of drainage through the rectum will suffice. Calculi of the seminal vesicles are occasionally found, usually atpost mortem. Often calculi give rise to no symptoms. Cases have beenreported, however, where the calculi have produced obstructive symp-toms—pain and seminal colic. These stones are, as a rule, soft, and theycan be crushed l^etween a sound introduced into the urethra and a fingerin the rectum. Tuberculosis of the seminal vesicles is the disease which mostfrequently brings these organs to the attention of the surgeon. It iscommonly found associated w^ith tuberculosis of the testicle, the diseasehaving extended to the vesicles from the testicle along the vas. Tuber-
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FiG. 348.—Tuberculosis of the Seminal Vesicles andTHE Lowest Portion of the Vas Deferens (Senn). 628 SURGERY OF THE SCROTUM, TESTICLE, AND CORD. culosis of the seminal vesicles may result from an extension to them of aprimary tuberculosis of the prostate. Primary tuberculosis of the seminalvesicles is not regarded as a probable lesion. In tuberculosis of theseminal vesicles the nodular thickening produced by the disease can befelt by rectal examination (Fig. 348). It has been found that in some cases tuberculosis of the seminal vesi-cles, secondary to tuberculosis of the testicles, goes on to cure after castra-tion has removed the primary focus. The operative removal of the seminal vesicles has not been verysuccessful and should not be undertaken unless it can be shown that thetuberculous lesion is limited to the vesicles and other structures, whichcan be removed. If an operation is decided upon, the Dittel-Zuckerkandlincision should be employed. (See Fig. 347.) The seminal vesicles

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