It is more than probable that if operative interference be carried out on thrombosed ovarian veins before the condition of the patients become desperate, more of them might be rescued. Success has been attained even in desperate conditions; for example, Friedemann ligatured these veins in a woman whose general condition was not only bad, but who also had extensive bed-sores. She recovered.
T. G. Stevens reported the details concerning a woman who died, of acute septicæmia, eleven days after a subtotal hysterectomy (by Galabin) for fibroids. The right ovarian vein was thrombosed from the ligature in the pelvis to its entrance into the vena cava, and he isolated from the clot and produced in cultures the bacillus pyocyaneus. He also stated that ‘the vein could have been easily dissected out, and possibly the fatal result might have been averted’.
This operation rests on sound principles, for the ligature of the ovarian veins prevents the septic blood entering the circulation, thereby setting up, among other things, endocarditis and pulmonary embolism.
The great difficulty in dealing with this condition is the selection of suitable cases. Experience teaches that acute cases are unsuitable. The best results have been attained in the chronic forms of the disease where the thrombosis was limited. There is great uncertainty in a given case as to the extent of the thrombosis and the number of veins implicated. As has already been mentioned, there are two routes for gaining access to the thrombosed vessels—the extraperitoneal and the intraperitoneal. I prefer the intraperitoneal route (cœliotomy), for it enables the surgeon to deal with the vessels, iliac or ovarian, of both sides, as well as allowing a thorough examination of the pelvic organs, and it permits the drainage of any collection of serum or pus found in the pelvis. From a study of the reported cases it is clear that the best results are obtained by cœliotomy. The ligature of thrombosed ovarian veins in chronic puerperal pyæmia promises good results for the future, but it needs further experience to teach us the kind of case in which it is likely to be successful.
References
Bumm, E. Zur operativen Behandlung der puerperalen Pyämie. Berliner Klin. Wochensch., 1905, xlii. 829.
Cuff, A. A Contribution to the Operative Treatment of Puerperal Pyæmia. Journ. of Obstet. and Gyn. of the British Empire, 1906, ix. 517.
Ferguson, J. Haig. Abdominal Hysterectomy for Acute Puerperal Metritis and Acute Salpingitis. Obstet. Transactions, Edin., 1906, xxxi. 123.
Friedemann, G. Die Unterbindung der Beckenvenen bei der pyämischen Form des Kindbettfiebers. Münchener Med. Wochensch., 1906, liii. 1813.
Lendon, A. A. Puerperal Infection, Thrombosis: Ligature of the Right Ovarian Vein. Australian Medical Journal, 1907, xxvi. 120.