References
Blacker, G. F. Clinical Lecture on Uterine Fibroids complicating Pregnancy. The Clinical Journal, 1908, xxxi. 309.
Küstner. Kaiserschnitt wegen eines Echinokokkus im Becken. Zentralbl. f. Gynäk., 1907, xxxi. 1390.
Skutsch, F. Ueber die Dermoidcysten des Beckenbindegewebes. Zeitsch. f. Geburts. and Gynäk., 1899, xl. 353.
Thornton, J. K. Removal of Hydatids of the Omentum and from the Pelvis. Medical Times and Gazette, 1878, ii. 565.
OPERATIONS FOR PUERPERAL SEPSIS (METASTATIC BACTERIÆMIA)
Acute septic infection (puerperal) of the uterus, too frequent even in this antiseptic epoch, is a desperate condition, but attempts have been made to deal with it by two methods—either hysterectomy, or the ligature and excision of the thrombosed ovarian veins.
So far as hysterectomy for this condition is concerned, it may be stated that it has been tried, but with no encouraging measure of success; it is a very desperate proceeding, and has been occasionally successful by the abdominal, as well as by the vaginal route. It is possible that vaginal hysterectomy may now and then be a wise operation in acute puerperal infection, but better results have been attained by ligature of the thrombosed pelvic veins, and by drainage of the pelvic cavity. Some interesting operations, with brilliant results, have been published by Trendelenburg, Michels, Cuff, Bumm, and others.
In some cases of puerperal pyæmia a careful examination of the patient’s abdomen has enabled the surgeon to feel the thrombosed ovarian vein, and in others the vein has been exposed by an incision running from the tip of the eleventh rib to the spine of the pubes, parallel with Poupart’s ligament. The muscles are divided and the peritoneum reached; this is reflected until the thrombosed ovarian vein is exposed and separated from the ureter. About half an inch below its junction with the renal vein or the vena cava, as the case may be, it is securely ligatured and divided; the vein is then slit up and the clot turned out. The operation, when carried out in this way, is extraperitoneal. In some instances successful ligature of the thrombosed ovarian vein has been effected by the usual median incision into the peritoneal cavity.
The object of ligaturing the thrombosed ovarian vein is to prevent the pathogenic micro-organisms in the clot from entering the circulation. Bumm reported five cases in which he ligatured these veins. Three of the patients recovered.