. A manual of gynæcology and pelvic surgery, for students and practitioners. onin pelvic surgery. When the tubes are occluded but freefrom dense adhesions the operation is simple, while the re-moval of a large densely adherent pyosalpinx which has per-forated into the rectum or bladder is one of the most difficultundertakings in surgery. Upon opening the abdomen under thelatter circumstances one may be confronted by old adhesionsroofing over the entire pelvic cavity, and these may cover adense mass consisting of the pelvic organs, omentum, small andlarge intestine, and bladder. The inexperienc
. A manual of gynæcology and pelvic surgery, for students and practitioners. onin pelvic surgery. When the tubes are occluded but freefrom dense adhesions the operation is simple, while the re-moval of a large densely adherent pyosalpinx which has per-forated into the rectum or bladder is one of the most difficultundertakings in surgery. Upon opening the abdomen under thelatter circumstances one may be confronted by old adhesionsroofing over the entire pelvic cavity, and these may cover adense mass consisting of the pelvic organs, omentum, small andlarge intestine, and bladder. The inexperienced operator 368 DISEASES OF-THE UTERINE TUBES should make it his first business to determine whether or no heis capable of extirpating the diseased organs. It is better toclose the abdomen at once than to break up adhesions, injureviscera, and then find that the case, so far as he is concerned, isinoperable. Should it be determined to proceed, the first stepis the separation of adhesions and demonstration of the dis-eased tubes. The omentum should be clamped and Hgated if. Fig. 193.—Chronic salpingitis with adhesions. Distended right tube adherentin normal position. Left tube buried in old adhesions. Uterus drawn to leftby adhesions to sigmoid. the adhesions are old and dense, or separated with the fingers ifrecent. As soon as the omentum is released, it, together withany coils of free intestine, should be lifted out of the pelvic basinand a wall of gauze pads be so arranged as to keep the intestinefrom crowding into the operative field, and at the same timeprevent soiling of the upper abdomen with any pus that maybe encountered. A line of cleavage between the adherent tubeand adjoining pelvic structures should be sought with the SALPINGECTOMY 369 finger. In long-standing cases this at first may seem impossible,but perseverance in attacking first one point and then another,even incising with the knife between visible coils of adherentintestine and the pelvic structures, fina
Size: 1855px × 1347px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, bookidman, booksubjectgynecology
