. A manual of gynæcology and pelvic surgery, for students and practitioners. their peritonealcovering. Should the cyst rupture during these manuevers itscontents are carefully sponged away and the now collapsed cystwall is drawn up out of the incision, where the separation ofadhesions is continued. The abdominal cavity above and aboutthe site of operation should be most carefully walled off bygauze packs, so that general peritoneal soiling may not takeplace in the event of injury to the tumor, the bladder, or theintestine. Should such injury occur to a viscus it is repairedat once if the damag
. A manual of gynæcology and pelvic surgery, for students and practitioners. their peritonealcovering. Should the cyst rupture during these manuevers itscontents are carefully sponged away and the now collapsed cystwall is drawn up out of the incision, where the separation ofadhesions is continued. The abdominal cavity above and aboutthe site of operation should be most carefully walled off bygauze packs, so that general peritoneal soiling may not takeplace in the event of injury to the tumor, the bladder, or theintestine. Should such injury occur to a viscus it is repairedat once if the damage implicates the muscular coat. At theclose of an operation in which the separation of dense ad-hesions has been a feature, the intestine to which the tumor was OVARIOTOMY 435 adherent should be carefully inspected, and areas deprived ofperitoneum be repaired by one or two sutures taken in Lem-bert fashion. Minute unprotected intestinal injuries unques-tionably are a common cause of death following the removal ofdensely adherent tumors. Once the tumor has been liberated,. Fig. 2 21.—Ovariotomy. Very large ovarian cysts must first be reduced in size by tapping. the operation proceeds as previously described for non-adherentgrowths. While the immense tumors of olden days are rare at thepresent time, an occasional cyst is encountered of such sizethat to remove it intact would require so long an incision as toseriously damage the integrity of the abdominal w^all. Inaddition to this the frequent presence of adhesions renders thetechnique considerably more difficult unless the growth is 436 DISEASES OF THE OVARIES reduced in size, so that cysts exceeding the size of a sevenmonths pregnant uterus are removed in the following a short incision is made, and after the anterior surfaceof the tumor is exposed the abdominal wall is held firmly againstit by the hands of an assistant making pressure on the outside.
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