Gynaecology for students and practitioners (1916) (14781735555)

Identifier: gynaecologyforst00eden (find matches)

Title: Gynaecology for students and practitioners

Year: 1916 (1910s)

Authors: Eden, Thomas Watts, 1864-

Subjects: Gynecology Gynecology

Publisher: New York : Macmillan

Contributing Library: Francis A. Countway Library of Medicine

Digitizing Sponsor: Open Knowledge Commons

Text Appearing Before Image:

f the surrounding muscular wall;which tend still further to dilate the cervix and expel the mass. Anatomy. In non-puerperal cases the size of the inverted uterusis never very large ; cases are not classed as chronic inversion untilfrom four to six weeks have elapsed since delivery, and during this periodinvolution proceeds with approximate regularity. The peritonealsurface of the uterus forms the cavity or cup of the inversion, and thisseldom exceeds 2\ inches in depth. Usually the cup is empty, butsometimes contains the Fallopian tubes and ovaries ; in acute puerperalcases a coil of the intestine may be contained in it, but this is neverfound in chronic cases, for persistence of the condition would clearly 586 GYNECOLOGY result in intestinal obstruction. Not infrequently the cup becomesobliterated by adhesion of the peritoneal surfaces, resulting probablyfrom infection which has gained entrance through the exposed mucoussurface. Obliteration of the inversion-cup greatly increases the

Text Appearing After Image:

Fig. 311. Complete Inversion of the Uterus and Vagina due to a Sub-mucous Fibroid (after Barnes), a, Uterine fundus, h. Tumour, c, In-verted vagina. difficulty of replacing the uterus. The edges of the cup form aprominent ring which is palpable by abdominal examination andis of great service in the diagnosis of the condition. The mucous surface in the earlier stages is much altered in appear-ance by congestion and oedema ; the openings of the Fallopian tubesare thus obscured. Later on superficial ulceration from traumatism CHRONIC INVERSION OF THE UTERUS 587 or infection may occur. Occasionally, in long-standing cases, cell-metaplasia from friction occurs, and the epithelium becomes stratified,taking on the external characters of vaginal mucous membrane. While puerperal inversion is nearly always complete, non-puerperalinversion is usually incomplete, and varies in extent from a mere depres-sion corresponding to the base of the tumour, up to the expulsion of thefundus into the vagina.

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1916

Francis A. Countway Library of Medicine

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