. Journal of radiology . hysical examination shows no finding of importance other than the presence of tenderareas. .X-ray observations after pneumoperitoneum has been produced show the uterus to be verysmall. Its identification from the confusing shadows of the distended bladder and loops ofintestines to be uncertain except for the line of the round ligament which extends upward tothe lateral wall in the illustration. Just proximal to the line of the round ligament a massoccurs, which appears under palpation to be fixed to the broad ligament and round ligament. The peritoneoscope shows this m
. Journal of radiology . hysical examination shows no finding of importance other than the presence of tenderareas. .X-ray observations after pneumoperitoneum has been produced show the uterus to be verysmall. Its identification from the confusing shadows of the distended bladder and loops ofintestines to be uncertain except for the line of the round ligament which extends upward tothe lateral wall in the illustration. Just proximal to the line of the round ligament a massoccurs, which appears under palpation to be fixed to the broad ligament and round ligament. The peritoneoscope shows this mass to have the usual appearance of a cystic ovary. Theperitoneum covering the oviduct, broad ligament and uterus seems pale, opaque and the usualglistening lustre is lost. A small number of typical tubercles were observed on the oviductanil lateral wall. The diagnosis was localized tubercular peritonitis with adhesions fixing the right ovary andoviduct to the broad ligament and lateral wall. 324 THE JOURNAL OF RADJOLOOY. Case 21. No. 3630The illustration is lateral view. Patient lying face upward. The history shows evidence of digestive disturbance for the past seven years—exaggeratedfor the past three months. Distress immediately upon eating. Loss of weight and strength. Physical examination elicits areas of extreme tenderness in the epigastrium. No tumormass. Barium meal shows constant filling defect in the stomach near the pylorus and theabsence of a normal duodenal cap. The peritoneoscope shows the presence of small metastasis in the peritoneum over the sur-face of the liver and in the gastro-colic omentum. The falciform ligament appears as a denseinfiltrated cord larger than a finger, for some distance away from the anterior abdominal wall,at which point it becomes a thin membrane, whose peritoneum shows the usual glisteningappearance. Diagnosis: Malignant metastasis from gastric carcinoma involving the stomach, duodenum,liver, omentum, etc. PEITONEOSCOPE — ORNDOFF 32
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