. Operative gynecology. FiG. 317.—Vermiform Appendix (App.) adherent toA Large Papillary Ovarian Cyst. Dec. 22, ^ Natural Size. 22 PRINCIPLES AND COMPLICATIONS COMMON TO ABDOMINAL OPERATIONS. ity or its lateral wall. The cases in which the vermiform appendix is mostlikely to be involved are those in which its free end hangs down over the pelvicbrim close to, or in contact with, an inflamed right tube. An inflammatoryaffection of the tube will in this way easily involve the appendix, and an appen-dicitis will, on the other hand, infect the tube; so that the appendicitis may beeither prim
. Operative gynecology. FiG. 317.—Vermiform Appendix (App.) adherent toA Large Papillary Ovarian Cyst. Dec. 22, ^ Natural Size. 22 PRINCIPLES AND COMPLICATIONS COMMON TO ABDOMINAL OPERATIONS. ity or its lateral wall. The cases in which the vermiform appendix is mostlikely to be involved are those in which its free end hangs down over the pelvicbrim close to, or in contact with, an inflamed right tube. An inflammatoryaffection of the tube will in this way easily involve the appendix, and an appen-dicitis will, on the other hand, infect the tube; so that the appendicitis may beeither primary or secondary, and the same may be said of the salpingitis. Whenthe appendicitis is secondary it is usually limited to the outer coats. In one of my cases in which the disease was primarily in the appendix thisorgan was perforated, the pelvis was filled -with pus, and the tube became in-flamed and the ovary gangrenous, appearing green and black. The patient sur-. FiG. 318.—Extensive Pelvic Inflammatohy Disease with Genekal Adhesions, due to TuBEitcrLAREndometritis, Pelvic Peritonitis,-Tuberculosis of both Tubes and of Eight Ovary. The ricrht ovary is 5 x 4x -3 centimeters in size, and is filled witli pus. The drawing is especially intendedto sliow tlie adlierent vermiform appendix. Path. No, 1071. Op. Feb. 15, 1S96. Natm-al size. vived the operation for the removal of these structures, and was up and goingabout when she died suddenly on the twenty-eighth day, suffocated by a largeperi-hepatic abscess rupturing into a bronchus. Gentle traction will sometimes suffice to free an adherent appendix, but be watched for a time to make sure that it will not continue to bleed if itis dropped without being removed. Sometimes a fine silk suture at the bleed-ing point will check the flow, but this is often not admissible, because the appen-dix tends to tear and bleed more freely after the puncture of a needle. If thehemorrhage persists,
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