Traumatic Rupture of the Left Kidney

Abstract

INTRODUCTORYThe case we are to report is of interest both to the clinician and to the surgeon. Our main reasons for presenting same are twofold: first, on account of the rarity of these cases, and, second, because there were no objective manifestations of trauma.Kuster, in 7,741 injuries at the clinics of Baser and Berlin, tabulates only 10 cases of injuries to the kidney, or a little more than 1: 1,000. Of these 10 only one was similar to the case now to be presented. Of 2,610 autopsies under his supervision, there was only one of a penetrating nature. Israel reports only one operative case, notwithstanding his large experience in renal surgery. REPORT OF CASEFamily History.\p=m-\IreneC., aged 11 years, was the fifth child of six living children. Her father and mother give a negative history in every detail, and her family history with reference to tuberculosis, malignancy and insanity was negative.Previous History.\p=m-\Born at 9 months, normal delivery. Breast fed entirely for one year, and with soft food until she had reached the age of 32 months. From that time on she had received full diet. Prior to her present illness she had never needed the attention of a physician. Present Illness.-In the forenoon, Aug. 5, 1915, while the patient was stand¬ ing on the edge of a wagon, with one foot balanced on a swinging gate, her little brother pulled the gate in the opposite direction, causing her to fall. In falling it is evident that she traumatized the middle and left lower quadrants of her body. Following this, she fell from the wagon to the ground, a distance of about 3% feet. She was unconscious for a few minutes, and after regaining her senses, complained of a "pain in her stomach" and about fifteen minutes later vomited. At 8 p. m., on the same date, she voided "a black urine," and at 9 p. m. had about 1 degree elevation of temperature. During the night she voided three times, the urine becoming clearer as time progressed. The follow¬ ing morning, Aug. 6, 1915, she had "frequent desire to urinate," however, unaccompanied by pain. She complained of a "drawing down pain" radiating from the region of the stomach to the vicinity of the kidney.