. Pelvic inflammation in women. arametritic abscess, fecal tumors,tubal pregnancy, hydro- and hematosalpinx, and ovarian tumors. Ovarian tumors are generally more nearly globular and not so closelyconnected with the uterus. Under anesthesia there is usually a sharpline of separation which can be made out between the cyst and theuterus. Large ovarian tumors are more readily recognized by their size,consistency, and absence of inflammatory signs. Tubal pregnancy, as a rule, can be diagnosticated by its typical his-tory and the alisence of an exudative mass. Fecal tumors are recognized by the pit
. Pelvic inflammation in women. arametritic abscess, fecal tumors,tubal pregnancy, hydro- and hematosalpinx, and ovarian tumors. Ovarian tumors are generally more nearly globular and not so closelyconnected with the uterus. Under anesthesia there is usually a sharpline of separation which can be made out between the cyst and theuterus. Large ovarian tumors are more readily recognized by their size,consistency, and absence of inflammatory signs. Tubal pregnancy, as a rule, can be diagnosticated by its typical his-tory and the alisence of an exudative mass. Fecal tumors are recognized by the pitting which can be made in SALPINGITIS 145 the mass, on pressure by the finger, through the vaginal wall or by rectalexploration and by enemata. A parametritic abscess usually displaces the uterus upward and to oneside, while pyosalpinx displaces forward and to one side. Parametricabscess always follows lalx)r, abortion, or intra-uterine instrumentation,and is so intimately blended with the uterus, that the lateral fornix, owing. Fig. 47.—A Pyosalpinx on One Side and a Tubo-ovarian Abscess on the the Authors Collection. to the swelling in the parametrial connective tissue, is efifaced and thecervix is flush with the vaginal vault. Hydrosalpinx presents the greatest difficulty in differential hydrosalpinx the pain, tenderness, and systemic disturbances are lessmarked than in pyosalpinx. The walls are thin and more fluctuant, andthe tumor may even be so flaccid as not to be appreciable to the bimanualtouch. Hematosalpinx, the result of tubal pregnancy, is distinguished by itsabrupt development, the characteristic metrorrhagia, and the physicalsigns. In acute inflammatory conditions within the pelvis satisfactorybimanual examination is often impossible without general surgical anes-thesia, owing to the exquisite pain produced by the manipulation, and 146 PELVIC INFLAMMATION IN WOMEN examination at this time almost invariably increases the inflammatoryreact
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