Operative gynecology : . plugthe pelvic outlet like a cork. The correct explanation is to be sought in thedifferent locations of the tear; in most cases it extends up the median line,and only branches superficially into the sulci, leaving the lower fibers of OLD COMPLETE RUPTURE OF THE RECTO-VAGINAL SEPTUM. 283 the levator ani muscle uninjured. When, in rare instances, the rupturepasses through the perineum centrally and also extends deeply into one or bothsulci, prolapse may occur. The sphincter ani muscle in cases of complete tear will vary in form,in different cases, from a simple broken ci
Operative gynecology : . plugthe pelvic outlet like a cork. The correct explanation is to be sought in thedifferent locations of the tear; in most cases it extends up the median line,and only branches superficially into the sulci, leaving the lower fibers of OLD COMPLETE RUPTURE OF THE RECTO-VAGINAL SEPTUM. 283 the levator ani muscle uninjured. When, in rare instances, the rupturepasses through the perineum centrally and also extends deeply into one or bothsulci, prolapse may occur. The sphincter ani muscle in cases of complete tear will vary in form,in different cases, from a simple broken circle, with its ends still bound to-gether, all the way to a shallow arc, in which case the muscle is short and thickwith a deep dimple in the skin behind it. A smooth glazed depression, attimes puckered or pitted, at the lower angle of the perineal scar, frequentlyserves as the sphincter landmark. A straight sphincter is the result of frequentcontractions pulling down the angle of the tear so that ultimately a deep tear. Fig. 154.—Complete Tear of the Recto-vaginal Septum. The rectal sutures all tied except the silkworm gut tension suture. The sutures are introduced butnot tied in the right vaginal sulcus, one of silkworm gut and two of catgut above it. comes to look like a superficial one. Thus the extent of separation of theends of the muscle becomes a measure of the depth of the original tear. It issometimes difficult to identify the sphincter ends upon simple inspection, butby pulling on or pinching the muscle so as to stimulate a contraction, the posi-tion of the ends may always be discovered. It is important not to be misled, 2S4 RUPTURE OF RECTO-VAGINAL SEPTUM AND RELAXED VAGINAL OUTLET. by the ability of the patient to retain feces, into the error of thinking the tearcan not be complete, for where the original rent is shallow and the cicatrixin the angle binds the ends firmly together, the sphincter will often contractefficiently up to this point. A similar result is,
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
