Uterine hæmatocele : experience in the Royal Infirmary / by J. Matthews Duncan.

  • Duncan, J. Matthews (James Matthews), 1826-1890.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Uterine hæmatocele : experience in the Royal Infirmary / by J. Matthews Duncan. Source: Wellcome Collection.

    15/16 (page 15)
    for discharge may certainly prevent increase of the size of the tumour, hut its freeness will not prevent the contents of the sac penetrating even in more than one new direction, a circumstance of which clinical observation has convinced me. The first case affords an example of opening the tumour by the ordinary paracentesis abdominis. In it and in case second, this mode of access to the sac was easier and more direct than that per vaginam. In the retro-uterine cases the tumour was opened per vaginam, and in all such cases no other method of operating should be resorted to. A trocar or a guarded bistoury may be used, the operator being careful to wound only in the mesial line, and to avoid injuring any vessel he may feel pulsating. It has been re¬ commended in cases of this description to pass the finger through the artificial opening, in order to break down clots and imaginary dissepiments; but such a proceeding is not possible, and were it possible it would not be advisable. In cases that are not retro¬ uterine, and on which operation per vaginam is decided upon, the surgeon should choose for incision or puncture the most prominent part, always taking care to avoid any vessel that can be felt, and not to injure the bladder or rectum. Rapid absorption of the effused blood (as happened in case second) is undoubtedly the most desirable termination of a hsematocele. But it does not often occur when the extravasation is large, and I cannot assign any reason why the histories of hsematoceles should in this respect be so widely different. Only it appears to me that the difference probably depends greatly on the condition of the extrava- sated blood. If it becomes dissolved and syruplike, I believe it becomes always mixed with pus, and is almost sure to be discharged and not absorbed. If it remains in the form of clot, it may be absorbed. In case second this persistence in the coagulated condition was rendered probable by the entire absence of fluctuation during its gradual diminution in bulk. The change into the tarry or syrupy condition is probably greatly dependent on the presence of inflammation of the sac, and secretion of pus. Mere bulk is not a sign of necessity for spontaneous or artificial evacuation, as the history of case second shows. But there can be little doubt that in large hematoceles absorption is less likely to occur than in smaller tumours. If these remarks have a good foundation, then, in cases where fluctuation can be anywhere felt, or where the dissolution of even a part of the effused blood has taken place, the question, whether evacuation of the contents of the sac will take place or not, has not to be decided: it will assuredly occur, and the surgeon has only to determine whether he will leave the case to nature or inter¬ fere, to hasten or direct the progress of the disease. PRINTED BY OLIVER AND BOYD, TWEEDDALE COURT, EDINBURGH.