The Harveian lectures on fibroids of the clinical and surgical standpoint : delivered before the Harveian Society of London on November 6th, 13th, and 20th, 1902 / by Alban H. G. Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: The Harveian lectures on fibroids of the clinical and surgical standpoint : delivered before the Harveian Society of London on November 6th, 13th, and 20th, 1902 / by Alban H. G. Doran. Source: Wellcome Collection.

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    The sessile fibroid of the broad ligament may attain a great size. As it is fixed it gives little trouble at first; it does not irritate the peritoneum by rolling about, nor does it worry the patient by setting up uterine haemorrhage. Ascites is not a common complication! When it grows to its full proportions, however, it is apt to cause grave pressure effects, whilst its maintenance is a tax on the patient. Ureteral obstruction may prove fatal even in cases where the tumour has not risen above the pelvic brim and has been overlooked during the patient’s life (Gouget). Emaciation and anasarca of the lower extremities are extremely common. The larger tumours of this class range from 10 to over 40 pounds in weight. The diagnosis of a fibroid of the broad ligament is not always difficult. When the tumour is distinctly solid and sessile and the abdominal walls are thin the outline of the uterus on the anterior surface of the tumour can be defined or even seen. The uterus can sometimes be slid about laterally on the tumour. The cervix lies high, close under the pubes, and is not rarely inaccessible. In most cases diagnosis is difficult as the outline of the uterus cannot always be made out and the sound cannot in every case be passed owing to the elevation of the cervix and its compression against the pubes Indeed, it is not always easy to make out by dissection after the operation that the tumour has developed independently of the cervix. This section shows how doubtful the origin of the fibroid may be. I removed this tumour three years ago with satis- factory results. One half is in the museum of St. Bartholo- mew’s Hospital, the other in the museum of Charing Cross Hospital. I think that the tumour might have arisen in the parametrium behind the cervix. The practical importance of this question is clear—a broad ligament fibr'oid may some- times be enucleated and the uterus spared ; in fibroid of the cervix this cannot be done. It is a serious thing to remove the uteru* of a young woman. The diagnosis of a soft or cystic sessile broad ligament fibroid is difficult even when the uterus can be clearly defined ; it then closely resembles certain sessile tumours of ovarian or parovarian origin. Pedunculated fibroids of the broad ligament are usually impossible to diagnose from subserous fibroids attached to a uterus otherwise but little enlarged, or from fibroma of the ovary. The treatment of fibroid of the broad ligament should, I believe, be surgical in any case. A sessile tumour of this class is not likely to be harmless, after the fashion of many a fibroid uterus lying high above t he pelvis and freely moveable. The dangers of operation steadily increase with the size of the tumour. The removal of a sessile broad ligament fibroid of any size demands careful enucleation. A small tumour of this class may be shelled out of the broad ligament, then, after the securing of all bleeding points and the uniting of the cut edges of the broad ligament by
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