Treatise on gynaecology : medical and surgical . may vary greatly, andin some places be hard and in others soft. Bimanual exploration willenable us to outline the body of the uterus, which seems to be encasedin the tumor that fills and more than fills the pelvis (Fig. 61). Rec-tal touch is greatly interfered with by the compression of the intes- INTRA- AISTD EXTEA-PERITONEAL PELVIC HiEMATOCELE. 229 tine. This compression may give rise to symptoms of internal stran-gulation; that of the bladder to retention of urine; that of the sacralplexus to acute neuralgias of the lower limbs. The general c
Treatise on gynaecology : medical and surgical . may vary greatly, andin some places be hard and in others soft. Bimanual exploration willenable us to outline the body of the uterus, which seems to be encasedin the tumor that fills and more than fills the pelvis (Fig. 61). Rec-tal touch is greatly interfered with by the compression of the intes- INTRA- AISTD EXTEA-PERITONEAL PELVIC HiEMATOCELE. 229 tine. This compression may give rise to symptoms of internal stran-gulation; that of the bladder to retention of urine; that of the sacralplexus to acute neuralgias of the lower limbs. The general conditionvaries; even when there is no suppuration, we frequently observeirregular attacks of fever, due to the peritoneal reaction caused by theformation of false membranes. ^ ^ The course of the disease is essentially chronic, but successiveacute attacks occur, as if additional amounts of blood were from timeto time effused. They may be manifested a few days after the onsetor later at the menstrual periods, no doubt under the influence of the. Fig. 61.—Retro-Uterine Hematocele. U, Uteras; B, bladder; ff, hsematocele. catamenial congestion. When the intra-peritoneal hemorrhage iscaused by the rupture of a foetal cyst, a relapse is especially to befeared, and may cause sudden death, even when it seems as though alldanger had passed. Outside of these exceptionally severe cases, thedisease tends to a cure by progressive absorption or spontaneousevacuation; the latter, however, which can only occur after suppura-tion of the sac, may cause grave accidents. In the most favorable cases the patient is unable to walk for manymonths, and is exposed to repeated slight attacks of peritonitis dur-ing which the tumor is subjected to changes of size and iinally di-minishes by degrees. After its disappearance, there may remain an 230 CLINICAL AND OPEEATIVE GYNECOLOGY. indurated nodule, or simply a displacement and immobility of theuterus. Suppurative inflammation is usliered in by an aggrava
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