. Atlas and epitome of gynecology . he rectum (Rectocele,Plate 5, Fig. 2). The upper half of the vagina is farless often the seat of inversion, the other organs carryingthe rectovesical or vesico-uterine folds of peritoneumahead of them. In the Atlas of Obstetric Diagnosisand Treatment (Figs. 102 to 105) cases of incarceratedretroflexed gravid uteri and of extra-uterine pregnancyare illustrated in which the gestation sac causes a protuber-ance of the vaginal wall. Among the rarer cases brought to our notice are ovario-colpocele, enterocolpocele (Plate 19, Fig. 1), hydrocolpo-cele, pyocolpocele
. Atlas and epitome of gynecology . he rectum (Rectocele,Plate 5, Fig. 2). The upper half of the vagina is farless often the seat of inversion, the other organs carryingthe rectovesical or vesico-uterine folds of peritoneumahead of them. In the Atlas of Obstetric Diagnosisand Treatment (Figs. 102 to 105) cases of incarceratedretroflexed gravid uteri and of extra-uterine pregnancyare illustrated in which the gestation sac causes a protuber-ance of the vaginal wall. Among the rarer cases brought to our notice are ovario-colpocele, enterocolpocele (Plate 19, Fig. 1), hydrocolpo-cele, pyocolpocele (Plate 58, Fig. 1, and Plate 59, Fig. 3),and those bulgings of the vaginal wall that are broughtabout by tumors of Douglas pouch (Plates 58 and 59), or 50 VAGINAL INVERSION. 51 of the rectovaginal or vaginovesical septa. (Plate 58,Fig. 3 ; Plate 88, Figs. 5 and 6.) If the ovary, intestine, or omentum becomes fixed inthe pouch of Douglas, it may cause the vaginal wall tobulge, so that in extreme cases it presents itself at the vul-. Fig. 23.—Inversion of both vaginal walls and inguinal hernia ofthe right labium in a case of lacerated perineum (photograph of anoriginal water-color). The two conditions are not infrequently associ-ated, as they have a common cause—relaxation of the supportingtissues. var opening. This is particularly true in cases of retro-flexion or prolapse of the uterus. The simultaneous in-version of the anterior and posterior vaginal walls is rare,because it could be caused only by an influence exerted at 52 VAGINAL AND UTERINE INVERSION. the same time on both recto-uterine and vesicouterine cul-desacs. It is rarely caused by ascites (with a retroflexedor vertical uterus), more frequently by pus or an encap-sulated peritoneal exudate (pyocolpocele). Diagnosis.—See scheme and differential diagnosis oftumors of the recto-uterine pouch, § 35. In ovariocele bimanual exploration reveals a charac-teristic form, sensitiveness, and relation to the tube anduter
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