File:Operative gynecology - (1906) (14760598936).jpg

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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utting across the vault of the vagina, detaching the cervix from the blad-der, and so separating the fistula for 1.5 cm. on all sides from the vaginaand uterus, laying bare a hole in the bladder wall 8 mm. in diameter.This was closed by four silkworm gut sutures introduced from side toside, with fine catgut between for accurate approximation; the cervical partof the fistula was left open, and the vaginal vault was not closed. (SeeFig. 263.) A vaginal pack was then put in and the bladder drained by acatheter. 438 AFFECTIONS OF THE URETHRA AND BLADDER. In two weeks the silkworm gut sutures were removed and the union foundperfect throughout. Other Vesical Fistulae.—Aside from the genital fistulas which have just beendiscussed, fistulous communications with other organs are but rarely observed.This immunity is due to the fact that some unusual accident is necessary toestablish a communication between the bladder and any of the other abdominalor pelvic viscera. Fig. 264.—Vesico-uteiuni
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in Place but not yet tied. A communication may be formed in this way between the bladder and atube or an ovary, and between the bladder and the small or large intestine.Communication between the bladder and a tube or an ovary is brought aboutin one of two ways: either (1) an abscess of the tube or ovary perforates thebroad ligament at its base and so finds its way into the bladder, or (2) anovarian tumor forms adhesions with the peritoneal portion of the bladder, the VESICAL FISTULiE. 439 septum becomes thinned out and finally breaks, and the contents of the cystescape by this avenue. An abscess perforating the broad ligament commonly finds its way into thebladder in the neighborhood of the right or left cornu—that is, at either end ofthe posterior fold. I have seen a case of a tuberculous abscess of the tube onthe right side of the pelvis discharging in this way. A suppurating dermoid cyst may break through into the bladderand the nature of the abscess be determined by the escape o

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