Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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l labor eight years before I saw her,and had suffered ever since the birth. Her periods had always been regularbefore her confinement, but she had never menstruated since, although suffer-ing greatly with the monthly molimina and from backache and pains in thelower abdomen. Six months before I saw her she had been kept in bed eightweeks by an attack of peritonitis. On making a vaginal examination under a bed cover, the finger entered alarge, smooth-walled cavity in which none of the expected landmarks could berecognized. This was found to be the bladder, with the urethra so widelydilated that two fingers could be introduced without pain; the external urethralorifice hung patulous and everted under the pubic arch. All that was left ofthe vagina on the vulvar side was a little pit of firm scar tissue 1 cm. in depthjust behind the urethra. Upon making a bimanual examination a chain of tumors was found fillingthe pelvis, lying one above another; at first they felt like a group of myomata,
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Fig. 211.—Coronal Section of an Old Atresia of the Vagina with Distention of the Vagina,Cervix, and Uterine Cavity with Menstrual Fluid. The Atresia occupies the LowerThird of the Vagina. but a closer examination showed that they fluctuated and formed a continuouscavity, with two shallow sulci between. The obliterated portion of the vaginawas 4 cm. long. The operation was performed in this way: The left index finger was intro-duced into the 1)1 adder and the thumb into the rectum until they touched thesac of fluid and held the atresic area between their palmar surfaces. Usingthese fingers as a guide to avoid injuring the rectum or the bladder, a large tro- RECTO-VAGINAL FISTULA. 341 car was introduced into the pit beneath the urethra and pushed up through theobliterated septum until it penetrated the sac. Upon withdrawing the trocar500 c.c. (about 16 ounces) of tarry blood escaped and the three sacs collapsed.By means of a uterine dilator the trocar puncture track was now enlarged u

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