. Operative gynecology. Fig. 440.—Suppurati Showing extensive attachments to the uterus, bladder, omentum, small intestine, and mesentery. Thebladder and the uterus are pulled high up out of the pelvis. Jan. 20, 1897. chapter on Complications Common to Abdominal Operations. I will here onlyinsist upon a few peculiarities connected with this group of tumors. The adhe-sions to the abdominal wall which sometimes take in the whole anterior parietesmust be detached with deliberate care to avoid dissecting off the peritoneumwith the ovarian sac. Such a faulty dissection is usually begun at the incis
. Operative gynecology. Fig. 440.—Suppurati Showing extensive attachments to the uterus, bladder, omentum, small intestine, and mesentery. Thebladder and the uterus are pulled high up out of the pelvis. Jan. 20, 1897. chapter on Complications Common to Abdominal Operations. I will here onlyinsist upon a few peculiarities connected with this group of tumors. The adhe-sions to the abdominal wall which sometimes take in the whole anterior parietesmust be detached with deliberate care to avoid dissecting off the peritoneumwith the ovarian sac. Such a faulty dissection is usually begun at the incisionby starting in the wrong plane of tissues, and it may then be continued outwarduntil, as I have seen done, nearly the whole anterior parietal peritoneum is de- 298 tached from its cellular base. All ordinary adhesions can usually be separatedby pushing the hand with open fingers in between the sac wall and the perito-neum, and opening andclosing the fingers witha shearing motion. Anyparticularly dense adhe-sions are best dealt withby leaving a portion ofthe outer fibrous layer ofthe sac adhering to theabdominal wall. Omen-tal adhesions, if exten-sive and dense, may betreated by sacrificing theentire omentum up to thetransverse colon. The general principleof treating intestinal ad-hesions is in all cases toavoid opening the lumenof the bowel, and thismay best be done by cut-ting through the outercoat of the sac and thenstripping this coat offfrom the rest and leaving it adherent to the bowel as a protection from the injurywhich would otherwise be inevitably inflicted in attempting a complete detach-ment of tlie entire tumor. This princijjle may be carried out whether the adhe-sion is small or large, and is of most avail in enu-cleating densely ad
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
