Hysterectomy for uterine fibroid disease in early pregnancy / by Alban H.G. Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
1902
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Licence: In copyright

Credit: Hysterectomy for uterine fibroid disease in early pregnancy / by Alban H.G. Doran. 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 the tumour or chronic septic changes in the appen dages is yet greater. There is also serious danger of flooding, which is hard to control when a fibroid exists. Dr. Donald and others0 referred to cases of induc- tion of labour in fibroid disease of the uterus which had ended badly. Caesarean section at term was contemplated but the patient’s health had been failing for several weeks and was now very unsatisfactory. The pulse was high and dysuria was becoming severe. It therefore was questionable whether it would be safe to leave her alone till the middle of May on the chance of saving the child, which is usually ill-developed in cases where a large mass fixed in the pelvis interferes with the development of the uterine body. Imme- diate operation seemed to be the safest course. The advantages and dangers of all three procedures were carefully explained to the patient who unhesitatingly begged to be relieved at once from her miserable con- dition. On Jan. 6th another severe attack of pain came on with rapid pulse. I therefore operated on Jan. 7th, Mr. A. C. Butler-Smythe assisting. Mr. F. W. Collingwood administered gas and ether. The patient was placed in the Trendelenburg position. The abdominal incision had to be prolonged for one inch above the umbilicus. The bladder was not drawn up but lay in its usual position. There was no free blood or clot in the peritoneal cavity and there were no signs of old or recent peritonitis. The uterus and tumour were drawn out of the wound with ease. I found the ovaries lying high up on the mass ; they looked unhealthy so I deter- mined not to save them. The left broad ligament was tense. I tied the ovarian vessels and then the round ligament and divided the broad ligament. The right ovarian vessels, which were very large, were then secured. The right round ligament, which was greatly stretched as it ran over the face of the tumour, had pulled the peritoneum around the interna] abdominal ring up against the tumour. This curious displacement, puzzling for the moment, was of course due to the manner in which the tumour had grown from behind and below to the right of the bladder upwards. I cut a flap of peritoneum on the front surface of the tumour Fig. 2. Dr. Cuthbert H. J. Lockyer took charge 0f the specimen prepared by Kaiserling's method. Its appearances are demonstrated in the illustration (Fig. 2) made by Dr. Roberts. The anterior part of the uterine wall has been removed, displaying the foetus (a female) jn the amniotic cavity, and the front part of the tumour has been cut away> showing its substance uniformly fibrous without any cysts. It is necrobiotic. It has been replaced in its capsule whence, as above explained, I had enucleated it during the operation. The fundus and upper part of the uterus are quite free from fibroid growths. The usual relations are very distorted, hence it is impossible to determine the precise site of origin of the tumour in the uterine walls, but the growth certainly arises in part from the lower segment and is also in part cervical. The supra-vaginal portion of the cervix, very thick, has been deflected out of the vertical line to the left. The Fig. 3. Caset2i seen. from in fr0Ilt- «• Body of aaa toneum, showing limits of enucleation. 1,gamont- ■>' I eri' which I then enucleated; it felt as though in a state of SSRl**r^.n7>« «» •*•*» veiel. were rlched and secured. I he flap was sewn over the stump after I had E 6 uterus- ‘eu the abdominal PWound was ?d’ Recovery was uneventful and the patient was in A“St’ 190Z- S1“> had completely regained 6 Loc. cit. Uterus and tumour, Case 3, taken before the uterine cavitv was opened to demonstrate the fcetus ; view frcrn in front with uterus slightly rotated to the right, a, Fundus of the uterus. 6, Large, hard, pedunculated fibroid above the pelvis, c, d, Other fibroids, chiefly in the cervix, e. Cervix cut across at operation. /, Fallopian tube, g, <7, Divided peritoneum, showing limits of enucleation. /i.Pedicle of large fibroid (6). (Museum, Royal College of Surgeons of England.) body of the uterus, softer than the tumour, was pressed to the left and thus compressed the cervix again.-t the fibroid. It is clear that the foetus was completely cut off from the pelvic cavity by the tumour. • Case 3. Newly married woman, aged 30 years; hypo- gastric pains early in the first pregnancy; pedunculated fibroid in the abdomen and large fibroid in the lower segment posteriorly, involving the cervix and opening up the broad ligament; hysterectomy at the. fourth month: recovery. A woman, aged 30 years, who had been married four months, was sent to me on March 22nd, 1902, by Mr. R. M. Boodle of Sittingbourne. She informed me that she had married in November, 1901, and the last period was seen on Dec. 13th to 17th. On Feb. 7th there was a slight show of blood. For two months the patient had suffered from pains in the hypogastrium There was also much retching which continued through the day She rightly believed that she was pregnant. Mr. Boodle detected a large tumour intimately connected with the uterus, whilst he found the os soft as in pregnancy, ihe patient was a robust young woman. The raise was slow and strong, the temperature was normal, and the appetite was good. Ihe vomiting and retching had increastd since the pregnancy, but though her appetite had always been good milk or soups often made her sick. The breasts were fairly large; there was no oozing from the nipples on pressure. here was a hard, oval swelling in the middle of the abdo- men, chiefly to the left, beginning a few inches above the pubes and extending almost to the left ribs. A soft body rose about three inches above the pubes, chiefly to the right.