The Harveian lectures on fibroids of the clinical and surgical standpoint : delivered before the Harveian Society of London on November 6th, 13th, and 20th, 1902 / by Alban H. G. Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: The Harveian lectures on fibroids of the clinical and surgical standpoint : delivered before the Harveian Society of London on November 6th, 13th, and 20th, 1902 / by Alban H. G. Doran. Source: Wellcome Collection.

    13/84 (page 5)
    t) Posteriorly the ovary projects into the peritoneal cavity, anteriorly the round ligament, in its course from the uterus to the inguinal canal passes under the anterior layer of the broad ligament. Below the level of the ovary the broad ligament is best distinguished by the name mesometrium sanctioned by Waldeyer.7 * The layers of the mesometrium as they descend part widely, the gap being filled by the parametrium, part of the pelvic connective tissue. The anterior layer soon turns sharply upwards over the corre- sponding side of the bladder and pelvic wall, to become the parietal peritoneum of the abdomen. Hence this fold forms the lateral continuation of the utero vesical pouch. Its relation to the bladder is very important and is often greatly altered by fibroids which develop in the anterior part of the uterus and grow outwards. Broad ligament fibroids cause yet greater displacement of this fold. Hence in operating on such cases the surgeon must make sure where the fundus of the bladder lies. Even when the fold is normal the bladder may be found in abnormal relation to it. Tandler and Halban describe and figure a case where the bladder, otherwise normal, was invested by the layers of one broad ligament/ When a fibroid of the broad ligament or uterus grows forwards and upwards, displacing this fold, it not only draws up the bladder on its anterior aspect but also insinuates itself between the abdominal parietes and the parietal peri- toneum. The same happens when a pelvic cyst and when a tubo-ligamentary pregnancy advances anteriorly, constituting the “anterior ligamentary pregnancy” of Taylor.9 In all cases the tumour lies in front of the peritoneal cavity. The parietal peritoneum behind it protects it from infection from intestine. I cannot understand why, in diagrams by Andersen and other anatomists of repute, drawings copied over and over again in text-books, the anterior layer of the broad ligament is represented as though it dipped down as low as the posterior. We all know that the posterior layer, which below the ovary forms part of the mesometrium, passes deeply downwards into the pelvic cavity to form the anterior part of Douglas’s pouch. Uterine and broad ligament fibroids sometimes grow back- wards and upwards, displacing the posterior layer of the mesometrium. This complication, much more frequent than displacement of the anterior layer, brings the tumour into close relation with the ureter, vagina, and rectum, which may be adherent and therefore liable to damage at an operation. The neighbourhood of the rectum involves 7 Das Becken, 1898. s Topographie des weiblichen Ureters. Plates xxxi. and xxxii. 9 Extra-uterine Pregnancy: A Clinical and Operative Study, p. 77. Also called “ sub-peritoneo-pelvic” or “ sub-peritoneo- abdominal pregnancy.” As the tumour lies away from intestine the chance of infection is slight.