Volume 1

Operative gynecology / by Howard A. Kelly.

  • Howard Atwood Kelly
Date:
1901, ©1898
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Operative gynecology / by Howard A. Kelly. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    simpler methods of reduction {Centralb.f. Gyn., 1893, I^To. 41) is in entire accord with the recent developments of gynecological surgery, and promises success in cases which it has hitlierto been found impossible to treat in a conservative manner. I have not yet had a case upon which I could try it, but, in view of the a])parent feasibility of the plan, I give the details of the operation. It is briefly this: The peritoneum is opened posterior to the uterus and the neck of the sac is incised, relieving the constriction and making it large enough to push the fundus through. The steps are conducted in the following manner: First, a wide transverse incision in Douglas' cul-de- sac opening the peritoneum. Second, the introduction of the index finger through this opening into the inver- sion funnel of the utei'us, and separation of any adhesions found. Third, a longitudinal in- cision through the posterior uterine wall, as nearly as jjos- sible in the median line. This begins about 2 centimeters below the inverted fundus and ends about 2 centimeters above the os externum, and extends all the way down to the peritoneum. Fourth, rein version of the uterus by fixing the funnel with the index finger in Douglas' pouch, and press- ing in the fundus with the thumb of the same hand. Fifth, suture of the uterine incision by deep and superficial sutures passed on the peritoneal surface. Sixth, closure of Douglas' cul-de-sac with sutures. Inversion due to Malignant Disease. — Inversion due to a mahgnant tumor of the fundus is rare, and I have seen but one case. The patient (J. H. B., No. 410, San., Jan. 19, 1897) presented herself on account of a fetid, watery, blood-tinged discharge which had continued for about a year with hemorrhages at intervals. I found the whole vagina above the levator ani filled with an ovoid mass about 8 by 6 by 4 centimeters, flattened antero-posteriorly, and attached at the