File:Pathology and treatment of diseases of women (1912) (14781669225).jpg

Identifier: pathologytreatme00mart (find matches)
Title: Pathology and treatment of diseases of women
Year: 1912 (1910s)
Authors: Martin, August Eduard, 1847- Jung, Ph. (Philipp Jacob), 1870-1918
Subjects: Gynecology Gynecology
Publisher: New York : Rebman company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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remains laterally in connection with the cervix, and if necessarythe entire vagina, the pelvic connective tissue, and the adnexal organsare removed in one piece (Fig. 133). The hemorrhage must be arrestedduring the entire course of the operation. The margin of the cut offvagina is sutured anteriorly and posteriorly, if possible, in such a waythat the peritoneal and vaginal margins come in contact with eachother. PATHOLOGY OF THE VAGINA AND UTERUS 291 Herewith the first part of the operation is completed. It is nownecessary to examine the retroperitoneal glands along the arteria iliacaand spermatica as far up as the lumbar region. All infiltrated glandsmust be removed. Their enucleation mostly succeeds by blunt dissection.The attached fat must be removed with them. Seldom only are glandsintimately adherent to the bloodvessels, even if they should extendbeneath and behind them. I have so far only once resected the venailiaca communis with its intimately adherent glandular masses to the
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Fig. 133.—Carcinomatous Uterus, Abdominally Extirpated together with the largestpart of the Pelvic Connective Tissue. The dotted lines designate the contour ofthe uterus. (Authors preparation.) extent of 3 cm. After all suspicious tissue-masses have been removedand the bleeding has been safely arrested the peritoneum is closed abovethe pelvic floor. With complete removal I prefer to insert loosely sterilegauze, which is brought out through the vagina. Amann has proposedto drain the empty cavities directly outward through the cavum ischio-rectal by rubber tube drains. Suturing the peritoneal margins withinthe ligamenta lata offers no difficulties. If the middle portions of theanterior and posterior vaginal walls were already closed by stitching ofthe peritoneum the overlying zone of peritoneal covering of the bladder 292 DISEASES OF WOMEN and rectum is united without any difficulties. Closure of the abdominalincision. Among the complications of the total extirpation, injuries of theu

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