Operative gynecology : . al efforts at manual reduction, the abdomen was opened, with aview to dilating the constricting ring from above, as was done by Thomas. Thisattempt, however, failed absolutely. A longitudinal incision was then madein the anterior margin of the funnel, and carried directly through the wall until the inverted cavity wasreached (see Fig. 363). Theuterus could now be easily re-inverted, and the incision in itswall, which was 12 cm. long,had the appearance of the in-cision in the typical Cesareansection (see Fig. 364). It wassutured immediately as in thatoperation and the a
Operative gynecology : . al efforts at manual reduction, the abdomen was opened, with aview to dilating the constricting ring from above, as was done by Thomas. Thisattempt, however, failed absolutely. A longitudinal incision was then madein the anterior margin of the funnel, and carried directly through the wall until the inverted cavity wasreached (see Fig. 363). Theuterus could now be easily re-inverted, and the incision in itswall, which was 12 cm. long,had the appearance of the in-cision in the typical Cesareansection (see Fig. 364). It wassutured immediately as in thatoperation and the abdomenclosed. The patient died sev-eral days later from the infec-tion present before she cameunder observation. If manual efforts at reduc-tion fail, and the infection pres-ent makes the operator think itunwise to risk soiling the peri-toneum by one of the above-mentioned procedures, it is more conservative to make no attempt to save theuterus, but immediately to resort to the third procedure, namely, Fig. 363.—Inverted Uterus which could not be Re-duced by Manipulation. Picture shows abdominal cavity opened and incisionin uterus indicated, which is required to reduce inversion. VAGINAL AMPUTATION OF THE UTERUS. 643 Vaginal Amputation of the Uterus.—After a thorough cleansing of the field,the uterus is enveloped in sterilized gauze, grasped, and drawn down; it isthen exposed by pulling back the posterior vaginal wall with a speculum,so that the neck of the sac at the vaginal vault is accessible. The amputationis now begun by cutting two flaps at the neck of the inverted uterus, one
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
