. The diagnosis of diseases of women . wellings in front of theuterus are uterine fibroids, tumors of the bladder and anteriorabdominal wall, persistent distention of the bladder, and, occasion-ally, distended tubes and ovaries. Adhesions behind the uteruscausing retroposition are largely confined to the peritoneal cavity,and involve the greater portion of the posterior surface of theuterus. These adhesions most frequently result from extension ofan inflammation from the tubes, which when inflamed commonlylie behind the uterus. In abnormal mobility of the uterus due to arelaxation of the norma
. The diagnosis of diseases of women . wellings in front of theuterus are uterine fibroids, tumors of the bladder and anteriorabdominal wall, persistent distention of the bladder, and, occasion-ally, distended tubes and ovaries. Adhesions behind the uteruscausing retroposition are largely confined to the peritoneal cavity,and involve the greater portion of the posterior surface of theuterus. These adhesions most frequently result from extension ofan inflammation from the tubes, which when inflamed commonlylie behind the uterus. In abnormal mobility of the uterus due to arelaxation of the normal supports the uterus falls into retropositionwhen the patient lies upon her back. (See Plate XXVI., Fig. 1.) It is most important to recognize the cause of the displacement,inasmuch as retroposition per se is of little clinical no tumor mass or adhesions are found in the pelvis and theretroposed uterus displays an abnormal mobility the displacementis regarded as due to relaxation of the uterine supports. PLATE Retrouterine Haematoma Crovvding the Cul-de-sac of Douglas Up and the Uterus Up^A/^ard and Forward. DIAGNOSIS OF MALPOSITIONS OF THE UTERUS 217 It is not always possible to diagnose the presence of adhesions,even when the examination is made under anaesthesia. All operatorsof experience will testify to the frequency with which perimetriticadhesions are unexpectedly found after opening the abdominalcavity. This fact alone would seem to render the Alexander opera-tion of shortening the round ligaments through the inguinal canalan uncertain procedure. Perimetritic adhesions are confined to surfaces normally coveredwith peritoneum. They are found with the greatest frequencyabout inflamed tubes and ovaries, and are therefore most commonlylocated beside or behind the uterus. The uterus is rarely absolutelyfixed. The degree of mobility depends upon the location of theadhesions, their extent, length, and firmness. Adhesions bindingthe uterus to movable s
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