Gynaecology for students and practitioners . his process usually takesplace from below upwards, the vagina is not inverted by the trac-tion exerted upon it by the falling uterus ; on the contrary, the latteris drawn out of the pelvic outlet by the inversion of the anterior wallof the vagina. That this is the true sequence may be demonstrated ina case of procidentia by watching the reappearance of the prolapsedparts after they have been reduced. If the patient is directed tostrain, the lower part of the anterior vaginal wall first appears, then the ANATOMY OF PROLAPSE 593 remainder of this
Gynaecology for students and practitioners . his process usually takesplace from below upwards, the vagina is not inverted by the trac-tion exerted upon it by the falling uterus ; on the contrary, the latteris drawn out of the pelvic outlet by the inversion of the anterior wallof the vagina. That this is the true sequence may be demonstrated ina case of procidentia by watching the reappearance of the prolapsedparts after they have been reduced. If the patient is directed tostrain, the lower part of the anterior vaginal wall first appears, then the ANATOMY OF PROLAPSE 593 remainder of this wall bringing with it the cervix, and lastly theposterior wall appears, being inverted in the reverse direction, above downwards. Procidentia is accordingly a combination ofcystocele with prolapsus uteri; the inversion of the posterior vaginalwall, as will be seen later, is not a true rectocele, but the mechanicalresult of the uterus being driven out of the pelvis. The structure of the hernial protrusion in cases of procidentia is. ^FALLOPIAM TUBEAND OMRY BLADDER UTERUS OS EXTERNUM Fig. 314. Procidentia Uteri, as seen in mesial sagittal section of the pelvis;the cervix is somewhat elongated (Berry Hart). shown in Figures 314 and 315, in sagittal mesial section. The protru-sion forms an inverted cone, the apex of which is formed by the portiovaginalis with the external os ; the outer coat or covering of the hernia isformed by the wall of the vagina, which is completely inverted, andcan be traced forwards to the urinary meatus and backwards to theperineal body. At the base of the hernia lie the mons Veneris in frontand the anus behind. The sections show that the whole of the bladderand the whole of the uterus lie within the hernia. The posteriorvaginal wall has been completely separated from the rectum ; only asmall portion of the anterior rectal wall is seen in Figure 315, while in 38 594 GYNECOLOGY Figure 314 it is seen that no part of the rectum has been drawn intoth
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
