Gynaecology for students and practitioners . minent,and pressure causes considerable pain. On palpation a dome-shapedswelling, ill-defined in outline and elastic in consistence, can bemade out. Its position is usually, but not always, mesial. Onpercussion the note is subresonant. The surface of the swelling feltin the hypogastrium corresponds to the roof of the hsematocele,which is formed by omentum and coils of intestine adherent to oneanother and to the mass of effused blood beneath them. 224 GYNECOLOGY On vaginal examination, it will be found that the whole uterus,including the cervix, is d
Gynaecology for students and practitioners . minent,and pressure causes considerable pain. On palpation a dome-shapedswelling, ill-defined in outline and elastic in consistence, can bemade out. Its position is usually, but not always, mesial. Onpercussion the note is subresonant. The surface of the swelling feltin the hypogastrium corresponds to the roof of the hsematocele,which is formed by omentum and coils of intestine adherent to oneanother and to the mass of effused blood beneath them. 224 GYNECOLOGY On vaginal examination, it will be found that the whole uterus,including the cervix, is displaced forwards and pressed close up tothe back of the symphysis pubis ; sometimes it is somewhat elevated,and may be displaced a little to one or other side of the middle of the lips of the os externum may be recognizable and thebody is often somewhat enlarged. The rest of the pelvis is occupiedby the effusion, which has crowded the uterus out of its normalposition ; sometimes it depresses the floor of the pouch of Douglas. Fig. 128. Pelvic Hematocele shown in Mesial Sagittal Section (Bumm).The section shows the haematocele distending the pouch of Douglas and pushing [the uterus forwards. Attached to the left wall of the haematocele is a tubalmole. and causes bulging of the posterior fornix. The consistence of theswelling is generally elastic ; it may be almost doughy in parts or,on the other hand, areas which feel firm and solid may be variations are probably due to incomplete or irregular coagula-tion of blood. The pelvic mass is continuous with that felt abovethe pubes. On rectal examination it may be found to fill the sacralhollow (Fig. 128) and compress the bowel ; thickening of the utero-sacral folds is also commonly felt and probably results from coagula-tion taking place upon their surfaces. CLINICAL FEATURES OF TUBAL PREGNANCY 225 Differejitial Diagnosis of Pelvic Hcematocele. In considering thispoint it must be recollected that, alt
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
