This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1887 edition. Excerpt: ...superiorly by the ovarian ligament, so that the upper part of the broad ligament is not unfolded. Expectant treatment should first be adopted. Interference is only required at a later period, when signs of decomposition appear, or when rupture is threatening or has occurred as the result of secondary ...
Read More
This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1887 edition. Excerpt: ...superiorly by the ovarian ligament, so that the upper part of the broad ligament is not unfolded. Expectant treatment should first be adopted. Interference is only required at a later period, when signs of decomposition appear, or when rupture is threatening or has occurred as the result of secondary changes in the peritoneum. Finally, puncture is indicated if absorption does not occur, if the extravasation has lasted for months and gives rise to severe symptoms. The vagina is the most favorable site for opening extra-peritoneal hzematomata. As the contents of the blood sac consist, in great part, of clots of fibrin, an incision 2 to 3 cm. long is necessary for the evacuation of these masses. After incision of the vaginal wall and checking the hemorrhage, perforation with the finger or grooved director, dilatation ' of the opening with the volsella or blunt-pointed bistoury, then evacuation of whatever is easily removed. Forced evacuation is dangerous, as it may give rise to-rupture of the sac wall or to renewed hemorrhages. Washing the sac with sponges dipped in corrosive sublimate, and the introduction of iodoform gauze, secure antisepsis better than the use of a glms tube and frequent irrigations. The second way of reaching an extra-peritoneal extravasation leads through the abdominal cavity. 1 Hegar even opened an intra-peritoneal abscess following gonorrhoeal salpingitis, through the ischio-rectal fossa. After dividing the pelvic diaphragm, a passage must be made through the sub-peritoneal space, which is 1% to 2 cm. high, before reaching the peritoneum. The large vessels of the pelvis and ureter are situated in the lateral part of this portion of the sub-peritoneal space, so that we must keep towards the middle, near the rectum....
Read Less
