If, before the week is over, the dressings become soiled or give out a bad odor, they should be at once renewed. They should also be removed whenever a high temperature, without being accompanied by tympanites, leads to the suspicion of cutaneous abscesses.
THE ACCIDENTS AND COMPLICATIONS OF OVARIOTOMY.—When by the breaking up of adhesions to it the liver is wounded, the bleeding surface can usually be stanched, as Koeberle has shown, by the ferric subsulphate applied to the raw surface by the finger. If this fails the actual cautery at a dull heat should be used.
If, unfortunately, an adherent portion of the bowel is torn open, the wound should be carefully closed with very fine silk by the continuous suture. The sutured portion is then fastened to the lower angle of the abdominal wound as a safeguard in case of the subsequent formation of stercoral fistula.63 Should the intestine be injured to any extent, the wound must be closed by two sets of fine silk sutures, the first set uniting the mucous edges of the wound by the continuous suture, the other set uniting one serous coat to the other at a line about one quarter of an inch distant from the wound. An ordinary cambric needle with fine sewing-silk will answer admirably for this purpose. In small wounds one continuous suture, carried through all the coats but the mucous, will suffice. A mere puncture can be closed by hooking it up and surrounding it by a single fine ligature.
63 "Discussion on a Paper by Garrigues," Am. Gynæcol. Soc. Trans., 1881.
Wounds of the bladder have frequently happened, but they are by no means necessarily fatal.64 These accidents are liable to occur when the bladder, being adherent to the cyst and carried upward by it, lies directly under the line of incision, or the bladder may be torn open while adhesions to it are being severed. The wound should at once be grasped by a pressure-forceps, the bladder emptied by the catheter, and the operation proceeded with. When the operation has been completed the wound in the bladder is attended to, and in one of the following ways: Either the vesical wound is brought up within the lips of the abdominal incision, and is closed by being included in the abdominal stitches, or it is closed by the continuous or Glover's suture, without including the mucous membrane in the stitches. A self-retaining catheter, such as the Skene-Goodman, must then be kept in the bladder for at least a week.
64 Eustache, Archives de Tocologie, April and May, 1880, pp. 193, 277; Boston Med. and Surg. Journal, Feb. 16, 1882, p. 153; British Med. Journ., Jan. 28, 1882, p. 115; Am. Journ. Med. Sci., Jan., 1883, p. 123.
One of the ureters will sometimes be torn across while pelvic adhesions are being broken up. This accident is most likely to happen during the enucleation of a cyst growing downward because enveloped in the folds of the broad ligament. It is almost always fatal, and is usually not discovered during the life of the patient, and, I am disposed to think, not often discovered after her death. Sometimes, however, urine will ooze out of the abdominal wound, and in rare cases the patient has recovered with a urinary fistula. In such a case Simon65 successfully removed the corresponding kidney; Nussbaum66 constructed an artificial ureter leading from the fistula to the bladder; and Tauffer67 inserted the upper end of the divided ureter into the bladder by an artificial opening. It, however, failed to unite, and he later made an artificial ureter.
65 Annales de Gynécologie, June, 1877.
66 Edinburgh Medical Journal, July, 1876, p. 1.
67 Archives de Tocologie, Avril, 1880, p. 201.