. Operative gynecology. gn tumorsand cysts and to the uterus aremore easily dealt with, inasmuchas a portion of the wall of the cyst,or a part of a tumor, or a pieceof the uterine wall may be cut offwith impunity and left attached tothe bowel to avoid opening it. Ifthere is oozing from this surfaceor from the intestine, it may bechecked either by cauterizing itlightly or by bringing together its-free edges with sutures. In one hundred cases of pel-vic inflammatory disease in whichhystero-salpingo-oophorectoray wasperformed the intestines were ad-herent either to the inflammatorystructures or a
. Operative gynecology. gn tumorsand cysts and to the uterus aremore easily dealt with, inasmuchas a portion of the wall of the cyst,or a part of a tumor, or a pieceof the uterine wall may be cut offwith impunity and left attached tothe bowel to avoid opening it. Ifthere is oozing from this surfaceor from the intestine, it may bechecked either by cauterizing itlightly or by bringing together its-free edges with sutures. In one hundred cases of pel-vic inflammatory disease in whichhystero-salpingo-oophorectoray wasperformed the intestines were ad-herent either to the inflammatorystructures or among themselves infifty-two cases. In twenty-four cases the intestine was injured in the enucleation, varying indegree from a simple laceration of the external coat to complete rapture of allthe coats. Appendical Adhesions. —A large percentage of pelvic inflamma-tory diseases and ovarian tumors are associated with adhesions to the vermiformappendix, which is quite often found flrmly attached to the mass by its extrem-. 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-
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