On effusions of blood in the neighbourhood of the uterus, or, The so-called periuterine haematocele : a thesis for the M.D. degree / by Henry M. Tuckwell.

  • Tuckwell, Henry M.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: On effusions of blood in the neighbourhood of the uterus, or, The so-called periuterine haematocele : a thesis for the M.D. degree / by Henry M. Tuckwell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    occupies, as demonstrable by post mortem evidence, and then to point out the various sources from whence it may flow. It may be stated most positively that in the majority of cases the blood is poured out into the sac of the peritonaeum, where, falling by natural gravitation into the most depending parts, it occupies especially the recto-uterine cul-de-sac of Douglas,—the well- known pouch that is formed by the reflexion of the peritonseum from the rectum on to the posterior surface of the uterus and upper part of the vagina. Hence the name of hjematocele retro-uterine given by Nelaton to this form of extravasation, a name that expresses admirably the nature and seat of the tumour, as it is commonly met with, but which is open to criticism on the ground that cases occur in which tumours of identically the same nature and dependent on the same patho- logical process hold a totally diff'erent position with regard to the uterus. On opening the abdomen of a person who has died of this affection, the appearance presented will differ much in cases where the ruptured vessel is large and the extravasation sudden and rapid, and in those where it is smaller and the extravasation slow and gradual: in the former, the whole of the cavity of the abdomen is found to be full of blood, part fluid, part clotted, with no more advanced signs of peritonitis than a general reddening and injection of the whole membrane; in the latter, the signs of peritonitis are much more developed, adhesions have formed be- tween the different organs, more especially those which occupy the pelvis, the original seat of the extravasation, and have given rise to a peculiar condition of the parts therein contained; the upper and posterior part of the uterus has become firmly united with the sigmoid flexure of the colon and with those coils of the small intestine which lie in contact with it, so as to convert the recto- uterine cul de sac into a complete adventitious cyst, containing more or less altered blood, limited anteriorly by the posterior sur- face of the uterus, upper part of the vagina, and posterior fold of the broad ligament, posteriorly by the rectum, and above by ad- hesions* It will thus be readily seen how the neighbouring organs must be pressed upon and displaced, if the efi'usion into this circumscribed space continue; the uterus and bladder are driven forwards and crushed against the pubis, while the rectum is thrust back and flattened against the sacrum; the adhesions above and the soft parts below gradually yield to the pressure,