A CASE OF STONE IN THE BLADDER PRESENTING A PECULIAR SYMPTOM- COMPLEX

By B. B. BHATTA, m.d., m.r.c.p. (Lond.)

Ojjg. Physician-in-Charge, Out-patient Department King George's Hospital, Lucknow

The following case is in my opinion of

sufficient interest to merit notice.

A young Punjabi Sikh, aged 22, came to my medical out-patients on the 9th October, 1931, complaining of

periodic attacks of dysentery for the last two years; for this he said he had been under the treatment of several qualified doctors and had taken two courses of emetine injections, a course of kurchi and bismuth iodide, and anv_ amount of the usual anti-dysentery mixtures. In spite of all this the attacks consisting of pain in the lower part of the abdomen, tenesmus, fre- quency of defalcation (40?50 times in 24 hours), prolapse of the rectum, and marked diminution in the quantity of urine, had recurred regularly every second or third week. All these symptoms usually lasted from 3 to 7 days, and then there was a sudden and complete relief. I was greatly struck by the peculiar train of

symptoms which this man described and which I had not met with before in cases of chronic dysentery. So I made some further enquiries from the patient and found

Feb., 1932] RECURRENT APPENDICITIS : UJWAL 85

that with the diminution in the quantity of urine there was also some dysuria, and that the relief from the symptoms came chiefly at night time and was preceded by passage of a large quantity of urine. The stools consisted mainly of mucus.

The first attack started with pain in the lower part ?

1 u a^^omeri f?r which he took a dose of magnesium

sulphate; from the next morning all the above symptoms made their appearance and have since been recurring regularly I thought of the possibility of a stone in the bladder which periodically came forward, obstructed the internal opening of the urethra causing severe

straining during micturition, and resulted in prolapse ol the rectum, tenesmus and discharge of mucus. As the patient was in the interval of the attacks, I was able to do a rectal examination; I felt by the bimanual method a mass as big as a walnut, projecting into the anterior wall of the rectum. The case was shown the

same^ evening at a meeting of the Old Boys' Association of the King George's Medical College, where after a good deal of discussion the case was left sub judice. suggestions of diverculitis, prostatic stone and hydro- nephrosis were made. The patient was admitted to the surgical wards on the 30th October, 1931, and operated on supra-pubically on the 2nd November, 1931, when a

Si?ne ConsistinS mostly ?f oxalates?of the size and shape of a walnut and weighing 23 grammes, was found lying freely in the bladder cavity. The patient made a complete recovery from this operation in 10 days and since then has had no recurrence of his symptoms.

The interest of this case lies in the fact that, though ̂

a large rough stone was ultimately found in the bladder, the patient only com-

plained of symptoms pertaining to the bowel and not to the bladder; this accounted for the fact that the diagnosis was missed for over two years. The regular periodicity, the absence of haematuria, and of any referred pain down the urethra, were all in my opinion very unusual for bladder calculi. Besides this, the shape of the stone was not such as could effectively obstruct the opening of the urethra.

I wish to express my thanks to Mr. R. N.

Bhatia, ̂

Professor of Surgery and Superinten- dent, King George's Hospital, under whose care the patient was, for permission to publish these notes.