Sub-peritoneal hysterectomy / by Heywood Smith.

  • Smith, Heywood
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Sub-peritoneal hysterectomy / by Heywood Smith. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of pelvis just behind os pubis. Uterine sound.—Upwards, forwards, right, then back 4inches, on the left, and pressed down into the pelvis is a very hard mass not easily movable. The operation was performed on June 2nd. Abdominal incision from just below umbilicus to pubes ; walls thin, front of tumour covered with left broad ligaments, and oviduct considerably elongated and thickened. Left ovary deep down, not felt. The broad ligament was partly separated from the tumour and the oviduct tied and divided. The tumour was found, an unusual occurrence in fibroids, to be extensively adherent to the bottom of the pelvis. It was separated from these, and it and the uterus drawn up out of the abdomen. An elastic ligature was passed round the cer- vix—the tumour was then peeled off the uterus to which it was intimately adherent on the left upper aspect—in doing this the uterus was considerably torn. The peritoneum was then divided above the level of the inner os and peeled down ; the cervix was transfixed and tied with silk in halves inside the peritoneal flaps, and the uterus together with the right ovary and oviduct cut away. There was some bleeding from the corner of the left broad ligament which was secured with catgut, and the uterine arteries on the other side separately. The pelvic peritoneal wound was then closed with an uninter- rupted suture of chromicised cat-gut, the peritoneum over the stump of the cervix, with Lembert’s stitches. Some bleeding- points in the pelvis from the torn adhesions were then ligatured, the light falling well into the pelvis as the patient’s head was towards the window and the body tilted up. A sponge wrung out of tincture of matico was temporarily packed into the pelvis. The wound was closed with 13 silk-worm sutures, and a glass drainage tube inserted because of the torn pelvic adhesions. The operation lasted r hour 35 minutes. On the sixth day the stitches were removed. Pain in region of left ovary and coloured discharge on June nth and 12th. Glass tube removed on 3rd day. Indications of suppuration supervened and pus came from the os uteri on July 6th. I Passed a pair of forceps up the os uteri and brought away the silk ligature that was around the cervix, and also the chromi-
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