Diseases of the ovaries : their diagnosis and treatment . I have just said that if a cyst is soclosely adherent that it is difficult to ascertain its exact bound-aries, it is better to empty it before attempting to separate it,than to run any risk either of separating the peritoneum from SEPAKATION OF ADHESIONS. 355 the abdominal wall, or of so rupturing the cyst that its contentsmight escape into the peritoneal cavity. And adhesions to theintestine or omentum, especially those at the posterior part ofthe cyst, are also better left until the cyst is emptied and drawnout, and the separation onl
Diseases of the ovaries : their diagnosis and treatment . I have just said that if a cyst is soclosely adherent that it is difficult to ascertain its exact bound-aries, it is better to empty it before attempting to separate it,than to run any risk either of separating the peritoneum from SEPAKATION OF ADHESIONS. 355 the abdominal wall, or of so rupturing the cyst that its contentsmight escape into the peritoneal cavity. And adhesions to theintestine or omentum, especially those at the posterior part ofthe cyst, are also better left until the cyst is emptied and drawnout, and the separation only completed when they can beconveniently seen. When adhesions are loose, or not extensive,and the cyst has been distinctly made out after the division ofthe peritoneum, the adhesions may generally be easily dividedby one or two fingers, or by inserting the whole hand betweenthe cyst and the abdominal wallâthe palmar surface next thetumour, and the fingers curved to adapt the shape of the handto the convexity of the cyst. Sometimes extensive adhesions. yield before a very slight force, but at others very considerableeffort is required to break them down. Adhesions are veryrarely so firm that knife or scissors become necessary to com-plete their separation; when this is the case, it is better to cutaway some small portion of the cyst and leave it adhering tothe intestine or some other viscus, than to do any damage byattempting to take away the whole of the cyst. I have neverdone this, as, after the cyst has been separated from the abdo-minal wall, emptied, and drawn out with the adhering portionsof intestine and omentum, I have always been able to makecomplete separation, although great care has been necessaryto avoid injury to the intestine. Occasionally, instead of 3o6 TAPPING THE CYST. separating adhering omentum, it is better to divide it atsome unattached point, after the application of a ligature or atemporary clamp, allowing the adhering portion to be removedwith the cyst
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Keywords: ., bookcentury1800, bookdecade1870, booksubjectgynecology, bookyear1
