. The diagnosis and treatment of diseases of women. oth deep andsuperficial if preferred. (Doderlein and Kronig—Opera-tice Gi/niikologie.) may be made interrupted or continuous. The latter are preferable, as they savetime. In the Hegar operation the lines of tension extend exclusively from sideto side. There is no downward pull on the cervix, which is a serious disadvan-tage of the Stoltz operation (purse-string operation.) 506 LACERATIONS AND FISTULA RECTO=VAQINAL FISTULA. From injuries in labor or from destructive ulceration or from other causes, fis-tulous openings may form, extending in va
. The diagnosis and treatment of diseases of women. oth deep andsuperficial if preferred. (Doderlein and Kronig—Opera-tice Gi/niikologie.) may be made interrupted or continuous. The latter are preferable, as they savetime. In the Hegar operation the lines of tension extend exclusively from sideto side. There is no downward pull on the cervix, which is a serious disadvan-tage of the Stoltz operation (purse-string operation.) 506 LACERATIONS AND FISTULA RECTO=VAQINAL FISTULA. From injuries in labor or from destructive ulceration or from other causes, fis-tulous openings may form, extending in various directions. The different varietiesof genital fistulae, with the name given to each, are shown in Fig. 524. A recto=vaginaI fistula is an opening from the rectum into the vagina. The sizeof the fistula may vary from a small tortuous tract, admitting only a small probeand permitting only gas or fluid to escape, to a large opening, involving a largepart of the recto-vaginal septum, and through which passes practically all therectal Fig. 524. Fistulae of the Genital Tract. 1. Urethro-vaginal fistula. 2. Vesico-vaginal fistula. 3. Recto-vaginal fistula. 4. Vesico-uterine fistula. 5. Uretero-vaginalfistula. 6. Intestino-vaginal fistula. (Gilliam—Practical Gynecology.) Etiology and Pathology. The following are the causes of recto-vaginal fistulae. I. Injuries in labor. In rare cases a hole may be torn through the recto-vaginalseptum, resulting directly in a fistula. Usually, however, a fistula resulting fromlabor, is due to a complete laceration of the perineum, which is repaired at once or RECTO-VAGINAL FISTULA 507 later, but fails to heal entirely. The lower part of the approximated surfacesunite, but a small part of the upper angle fails to heal, and the result is a fistulaextending from the rectum into the vagina. 2. Chronic ulceration of the posterior vaginal wall, which may be chancroidalor syphilitic or tubercular. It usually affects the lower part of the
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