SUMMARY Six cases of spontaneous rupture of the bladder are described, and reviewed together with sixty‐six cases collected from the literature in the last twenty‐five years. There were sixty‐six cases of intraperitoneal rupture, five cases of extraperitoneal rupture, and one case of combined intraperitoneal and extraperitoneal rupture. The cases of intraperitoneal rupture are classified into two main groups according to whether there was a lesion of the bladder wall or whether the rupture was secondary to retention. The retention group is divided into three sub‐groups: one with neurological disorders, one with urinary obstruction, and a third miscellaneous group, where the rupture is considered to be secondary to a reflex retention. Rupture usually occurs through the vault of the bladder and is usually small in lesions of the bladder wall. Diagnosis depends on a history of pain and disturbance of micturition, and the signs of peritonitis. Catheterisation and withdrawal of blood‐stained urine confirms the diagnosis, but occasionally the urine is clear. The mortality was 47 per cent, and has not fallen during the last twenty‐five years. Carcinoma, tuberculosis, and enlarged prostate accounted for two‐thirds of the mortality.

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The use of a choledochoscope after exploration of the common bile ducts should minimize the occurrence of retained common bile duct stones. Experience gained at 50 endoscopies with a rigid choledochoscope is reviewed. In 7 cases stones or debris were found remaining in the bile duct. In one case an unsuspected neoplasm was demonstrated and in another a suspected neoplastic stricture was confirmed. In the remaining 41 cases choledochoscopy showed the ducts to be free of stones. Postoperative cholangiography demonstrated a retained stone in 2 cases. There were 2 deaths in the series. The experience of other authors with rigid and flexible scopes is reviewed.

if a complete gap exists after excising the aneurysm, as in Case 4. If, however, a portion of the normal aortic wall remains, then a 'patch' of plastic material can be sutured to the lips of the defect, as in Case 5. SUMMARY I. Five cases of traumatic rupture of the aorta are described; 3 being acute and 2 chronic traumatic aneurysms. One of the latter was successfully excised.2 . The lesion should be suspected in all cases of deceleration injury.3. The aetiology, diagnosis, and management are briefly discussed.Addendum.-Since submitting this paper we have seen I further case of traumatic rupture of the aorta almost identical with Case 3. A 21-year-old man was thrown forward when the car in which he was travelling as a passenger veered off the road and struck a tree. Shortly afterwards he complained of pain in his chest and developed numbness in his legs which rapidly became paraplegic. There were no other external signs of injury. A chest radiograph demonstrated a mediastinal haematoma and the left radial pulse was diminished. On this evidence traumatic rupture of the aorta was diagnosed. I n view of the cord signs urgent thoracotomy was performed, but fatal catastrophic rupture of the periaortic haematoma occurred just after the chest was opened. Although this was temporarilycontrolled, irreversible ventricular fibrillation ensued.Vol. 53, No. 4, APRILWe would like to thank Mr. W. J. Fulford, for permission to include Cases I and 2, and our colleagues of the Birmingham Accident Hospital who allowed us to see and treat Case 3.

SENIOR SURGICAL REGISTRAR, THE LONDON HOSPITAI BLOOD-BORNE metastatic tumours of the intestines are rare, and the following case report of a blood-borne metastasis in the caecum from a primary neoplasm of the cervix was considered worth recording.T h e metastasis occurred at the ileocaecal valve, and 'tertiary ' deposits in the regional lymph-nodes draining this area were found. Presumably the route of spread was via the blood-stream, but there was no evidence of metastases elsewhere at the time of operation, nor was any local recurrence discovered.T h e patient presented with a mobile mass in the right iliac fossa and, both before and at operation, was thought to be suffering from a primary carcinoma of the czcum. Right hemicolectomy was, therefore, done, and the patient made a satisfactory immediate recovery. Unfortunately, seven months later she developed evidence of spinal metastases.