. The diagnosis of diseases of women . ure of the lesion issuspected. 4. Carcinomatous Peritonitis. Carcinomatous peritonitis aris-ing from a cancerous focus in the uterus, tubes, and ovaries maygive rise to many of the symptoms common to peritonitis. It is especially difficult to differentiate a carcinomatous peritonitisfrom a tuberculous peritonitis. The discovery of the primary lesionwill suggest the diagnosis. Even after opening the abdominal cavity the diagnosis may beuncertain and require a microscopic examination of an excisedportion. THE DIAGNOSIS OF PERITONITIS 473 II. PELVIC PERITONI
. The diagnosis of diseases of women . ure of the lesion issuspected. 4. Carcinomatous Peritonitis. Carcinomatous peritonitis aris-ing from a cancerous focus in the uterus, tubes, and ovaries maygive rise to many of the symptoms common to peritonitis. It is especially difficult to differentiate a carcinomatous peritonitisfrom a tuberculous peritonitis. The discovery of the primary lesionwill suggest the diagnosis. Even after opening the abdominal cavity the diagnosis may beuncertain and require a microscopic examination of an excisedportion. THE DIAGNOSIS OF PERITONITIS 473 II. PELVIC PERITONITIS. Definition. Part or all of the pelvic peritoneum is involved inthe inflammatory process. We therefore speak of diffuse andlocalized pelvic peritonitis. When localized various terms are em-ployed to designate the location and extent of the lesion. Wespeak of ^perimetritis when the peritoneal covering of the uterus isinvolved; of perisalpingitis and periovaritis when involving theperitoneal coverings of the tube and ovary. Fig. 189. \ M. Levator ani,^ Three di\dsions of the pelvic cavity, viz., peritoneal, subperitoneal, and subcutaneous. (Fehling.) Of greater clinical importance is the distinction between a generalabdominal and pelvic peritonitis and a well-defined pelvic peri-tonitis. A pelvic peritonitis may be primary or secondary to ageneral abdominal peritonitis—a fact of prime importance in itsbearing upon the diagnosis and treatment. The infection is usually conveyed through the uterus and tubesto the peritoneum immediately surrounding these organs. A direct 474 SPECIAL DIAGNOSIS invasion from the uterus, tubes, rectum, appendix vermiformis, orbladder occurs with less frequency. It is possible for infection to be conveyed along the mucosa of theuterus and tubes to the peritoneum without causing anatomicalchanges in the uterus and tubes, or such changes may be limited toportions of the mucosa. Likewise, the lymphatic channels may be mere carriers of infec-tion witho
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