Operative gynecology : . Fig. 363.—Inverted Uterus which could not be Re-duced by Manipulation. Picture shows abdominal cavity opened and incisionin uterus indicated, which is required to reduce inversion. VAGINAL AMPUTATION OF THE UTERUS. 643 Vaginal Amputation of the Uterus.—After a thorough cleansing of the field,the uterus is enveloped in sterilized gauze, grasped, and drawn down; it isthen exposed by pulling back the posterior vaginal wall with a speculum,so that the neck of the sac at the vaginal vault is accessible. The amputationis now begun by cutting two flaps at the neck of the inve
Operative gynecology : . Fig. 363.—Inverted Uterus which could not be Re-duced by Manipulation. Picture shows abdominal cavity opened and incisionin uterus indicated, which is required to reduce inversion. VAGINAL AMPUTATION OF THE UTERUS. 643 Vaginal Amputation of the Uterus.—After a thorough cleansing of the field,the uterus is enveloped in sterilized gauze, grasped, and drawn down; it isthen exposed by pulling back the posterior vaginal wall with a speculum,so that the neck of the sac at the vaginal vault is accessible. The amputationis now begun by cutting two flaps at the neck of the inverted uterus, one. Fig. 364.—The Uterus after Inversion has been Reduced, Showing Long Incision in theUterus made through Abdominal Wall. anterior and one posterior, just below the vault of the vagina. Before theperitoneum is opened, three or four stout silk ligatures are passed with a largecurved needle completely through the uterine stump in an antero-posteriordirection. The peritoneum is now cut through in front, and by continuing the incisioncautiously up to the sides, the uterine arteries and veins are found, clamped,and tied with fine silk as high up as possible. An assistant maintains a strongtraction on the ligatures to keep the stump from inverting into the operator now takes the ligatures one at a time and ties them tightly, bring-ing the lips of the stump firmly together. Additional deep sutures must bepassed, if necessary, to check bleeding and secure accurate stump closed in this way soon slips through the cervix and a partial rein-version is established.
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
