Abdominal surgery . it descends to the junctionof the body and the cervix, it is lessintimately attached to the musculartissue ; and, at the bottom of thevesico-uterine depression, it is soloosely attached that it can readilybe stripped with the finger. Here isthe most important surgical reflection of peritoneum fromuterus to bladder is usually at thelevel of the internal os, but it isliable to be elevated or depressed.(Fig. 15.) In children it is higherup, in multiparae and old women itis lower down, than the averagelevel. In close relation with theunder surface of the vesico-uteri
Abdominal surgery . it descends to the junctionof the body and the cervix, it is lessintimately attached to the musculartissue ; and, at the bottom of thevesico-uterine depression, it is soloosely attached that it can readilybe stripped with the finger. Here isthe most important surgical reflection of peritoneum fromuterus to bladder is usually at thelevel of the internal os, but it isliable to be elevated or depressed.(Fig. 15.) In children it is higherup, in multiparae and old women itis lower down, than the averagelevel. In close relation with theunder surface of the vesico-uterinepouch lie the base of the bladder,and the ureters imbedded in cellulartissue. The bladder wall, for a dis-tance of fourteen millimetres, lies on the cervix uteri; belowthis, as far as the pubes, it rests on the vagina. Courty foundsas a result of a great number of measurements taken at allages, that the distance between the opening of the ureter intothe bladder and the insertion of the vagfina into the cervix was. Fig. 15. Vertical antero-posteriov section ofthe 2itevus. (Courty.) i, isthmus separating the cavity ofthe body from that of the cervix; a,anterior lip of the cervix; p, poste-rior lip; /, posterior vagino-uterinecul-de-sac; va, va, vagina; b, b, con-nections of the urinary bladder withthe anterior surface of the cervix ; r,reflection of the peritonem from theposterior surface of the uterus andvagina to the rectum; c, commence-ment of the utero-lumbar suspensoryligaments. SURGICAL ANATOMY. _ 177 on an average between one and two centimetres in length. Thedistance between the margin of the uterus and the ureter variesaccording to the size of the cervix, and also according to thecondition of the bladder as to emptiness or distension. With anempty bladder and a normal uterus a distance of quite half aninch may be reckoned upon as separating the cervix from theinsertion of the ureter into the bladder wall. The peritoneum covering the posterior surface of the uterusis co
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Keywords: ., bookcentury1800, bookdecade1880, bookpublisherlondo, bookyear1887
