. Operative gynecology. s is present unusual care must be taken to diminish the risks ofinfection by asj^irating and taking away as much of it as possible, and then pro-tecting the infected structures by abundant gauze until they are removed. Therisk of an infection is greater here than in almost any other abdominal opera-tion on account of the -wide area of cellular tissue bared between the broad liga-ments by the enucleation of the uterus and 376 MYOMECTOMY—HYSTERO-MYOMECTOMY. Adhesions, hydrosalpinx, and pelvic abscesses in theright side are best dealt with toward the end of the e
. Operative gynecology. s is present unusual care must be taken to diminish the risks ofinfection by asj^irating and taking away as much of it as possible, and then pro-tecting the infected structures by abundant gauze until they are removed. Therisk of an infection is greater here than in almost any other abdominal opera-tion on account of the -wide area of cellular tissue bared between the broad liga-ments by the enucleation of the uterus and 376 MYOMECTOMY—HYSTERO-MYOMECTOMY. Adhesions, hydrosalpinx, and pelvic abscesses in theright side are best dealt with toward the end of the enu-cleation; as the uterus is rolled up and out of the pelvis after clamping theright uterine artery, the right adnexa can be easily reached and fieed from adhe-sions under inspection by attacking them from the front. One of the most compUcated cases is shown in Fig. 501. The patient had a large umbilical hernia, containing a portion of the omen-tum, which adhered to the edges of the ring; the omentum was also closely. Dntest Fig. 501.—Complicated Hystero-myomectomy. The abdomen is filled with a large myomatous uterus with intestinal and omental adhesions. There isan umbilical liernia, and on the right side of the pelvis a large abscess opening into the small intestine. Infront of the abscess lies the uterine tube full of pus. Enucleation. Eecovery. K. L. Operation, March 24,1897. adherent to the whole front of the large myomatous uterus, which extendedfrom the pelvic floor well above the umbilicus. The adherent bladder wasdrawn high up out of the pelvis, and over it lay a large thickened uterinetulje distended with pus, while on the right side there was a suppurating COMPLICATIONS OF HYSTERO-JIYOMECTOMY. 377 ovarian cyst communicating by a fistulous opening with a loop of the smallintestine. The proper plan of procedure in such a case is to work with greatdeliberation until the adhesions are separated sufficiently to allow the myoma-tous uterus to be handled and to expose
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
