Gynaecology for students and practitioners . ndus, h. Tumour, c, In-verted vagina. difficulty of replacing the uterus. The edges of the cup form aprominent ring which is palpable by abdominal examination andis of great service in the diagnosis of the condition. The mucous surface in the earlier stages is much altered in appear-ance by congestion and oedema ; the openings of the Fallopian tubesare thus obscured. Later on superficial ulceration from traumatism CHRONIC INVERSION OF THE UTERUS 587 or infection may occur. Occasionally, in long-standing cases, cell-metaplasia from friction occurs, a
Gynaecology for students and practitioners . ndus, h. Tumour, c, In-verted vagina. difficulty of replacing the uterus. The edges of the cup form aprominent ring which is palpable by abdominal examination andis of great service in the diagnosis of the condition. The mucous surface in the earlier stages is much altered in appear-ance by congestion and oedema ; the openings of the Fallopian tubesare thus obscured. Later on superficial ulceration from traumatism CHRONIC INVERSION OF THE UTERUS 587 or infection may occur. Occasionally, in long-standing cases, cell-metaplasia from friction occurs, and the epithelium becomes stratified,taking on the external characters of vaginal mucous membrane. While puerperal inversion is nearly always complete, non-puerperalinversion is usually incomplete, and varies in extent from a mere depres-sion corresponding to the base of the tumour, up to the expulsion of thefundus into the vagina. In rare instances {sei Fig. 311) completeinversion both of the uterus and the vagina may, however, take Fig. 312. Incomplete ChronicInversion of the Uterus (diagrammatic,after Haultain). The tube and ovary are seen lying above the inverted uterus. The attachment of the tumour is usually fundal, but may be eithersessile or polypoid. Clinical Features. The prominent symptom of chronic inversion isirregular haemorrhage, dating in puerperal cases from the last confine-ment ; the bleeding may be very severe and has sometimes provedfatal. In addition, the patient may complain of the presence of atumour, or of the womb coming down. The diagnosis can onlybe made by physical examination, and while in complete puerperalcases this is very easy, in partial cases associated with a tumour,great care is required to avoid mistakes. The completely inverted uterus forms a pyriform swelling, occupyingthe upper part of the vaginal canal. It is smooth, dark red in colour, 588 GYNECOLOGY and usually bleeds readily on being handled. The orifices of theFallopian tub
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
