Littre's Hernia

LITTRE'S HERNIA, see Meckel's diverticulum. \ LITTRE'S GLANDS (Littre) are located in the mucous membrane of the urethra, well developed in men and in a rudimentary state in women. The name L. g. dates back to 1700, when Littre first described in his work published in Memoires de l'Academie a ring-like glandular body surrounding the urinary canal, the excretory ducts of which open along the entire periphery of the urethra, covering it with their orifices. Thus, the external sphincter was considered by him to be a gland. Jarjavay was the first to notice this error, and Oberdieck and Zvine protested against the incorrect name. The name L. g. has become firmly established among clinicians to this day, and all modern textbooks describe Littre's urethral glands. - L. g. develop from the middle germ layer by its ingrowth in the form of dichotomously branching cords. Urethral glands are most often formed by an indentation of the mucous membrane, as if by its depression, and are lined with cylindrical epithelium, in contrast to true glands lined with goblet epithelium. Thus, both embryologically and anatomically, they are false glands. L. g. are sometimes solitary, but more often in groups of 4-5 or more, mainly in the anterior part of the canal on its dorsal wall, where they are best developed. In the posterior urethra and on the lateral and lower walls of the anterior urethra, they are less common and usually in a rudimentary state. The depth of their penetration into the thickness of the mucous membrane varies: their body is located either under the epithelium or lies deeply, penetrating even into the thickness of the cavernous bodies. Their excretory duct is directed toward the external opening of the urethra and, depending on the depth of the gland's location, has different lengths. L. g. secrete mucus intended to lubricate the urinary canal. In pathology of inflammation of the urinary canal, these glands play a primary role, as infection present in the urethra can penetrate into the excretory ducts of the glands and cause their inflammation. Barely visible in urethroscopy under normal conditions, L. g. change sharply during inflammation, when on somewhat swollen and hyperemic mucosa the inflamed pinpoint opening stands out sharply. When the body of the glands is involved in the inflammatory process, the urethroscopic picture changes, and besides the inflamed pinpoint opening directly under it or nearby, a bulging body can be seen, which may simulate a soft infiltrate. When pressure is applied from the outside, one can see through the endoscope the mucopurulent content exiting the gland cavity. When the excretory duct is obliterated or compressed, empyema of L. g. occurs, and palpation with a straight metal bougie reveals one or several sausage-shaped formations. The urine in acute inflammation of L. g. is turbid, with admixture of comma-shaped threads in the first portion. - Prevention of inflammation of L. g. consists in gentle manipulation of the affected urinary canal. Expression of secretion from the canal (milking), rough painful washing according to Janet, early instrumental intervention, high concentration of solutions and other such trauma to the mucous membrane, and consequently a decrease in the vital tone of tissues, predispose to the appearance of inflammation of L. g. Inflammation of the excretory ducts involved in the inflammatory process, as a rule, does not require any special treatment, and with extensive washings of the urethra, infiltrates both inside and outside them resolve. - Therapy of inflammation of the glands themselves in chronic cases consists in massage on a straight bougie, dilation of the urethral lumen and thereby the lumen of the glands with bougies or dilators, and tamponade of the urethra. When pus accumulates in individual glands in both acute and chronic cases as a result of obliteration or narrowing of the excretory duct of L. g., puncture from the urethral side through the endoscope or aspiration of pathological secretion from the outside with a syringe can be recommended, and finally, when sufficiently detached from the urethra, surgical intervention in the form of excision of the gland. - The prognosis of the inflammatory process in L. g. depends on the degree of their damage. In superficial catarrh of the glands and with rational treatment, restitutio ad integrum occurs. With deeper lesions and involvement of the body of the glands in the process, obliteration of their cavity may occur due to proliferation of connective tissue elements and formation of a scar.