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.

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    adhesions, we might expect, going by logic instead of by observation, that adhesions are frequent in cystic uterine fibroids, but this is contrary to my experience. A fibroid, by the way, is not truly cystic unless it includes a big cavity containing at least half a pint of fluid. The pathological dilatations of lymphatics which resemble cysts on section are not true cysts and if two or three pints of serum drain away from such a tumour after removal and section the growth is in no sense cystic, but oedematous if not necrotic. I may add here that oedema in itself is no promoter of adhesions. Of my own cases of true cystic myoma one held 25 pints of serum and weighed 10 pounds 6 ounces ;6 there was no evidence of sepsis but the patient was overworked and emaciated and had recently suffered from severe abdominal pains. Had the tumour been ovarian adhesions would almost certainly have existed. In another case the contents of the cyst were two pints of turbid red septic fluid and the patient had been laid up for two months with severe abdominal pains. Yet I did not find one single adhesion. The serre-noeud was used in both these cases. The fact that intestinal adhesions are relatively rare is most important for us to remember and most fortunate for the patient who undergoes operation. Small intestine adhesions in a case of a large ovarian cyst are a distinct source of danger. A dense adhesion of the ileum is so serious a matter that it is often best to resect the adherent piece of gut. Intestinal adhesions to malignant ovarian tumours are specially perilous. But ovariotomy is impera- tive in a case of ovarian tumour. Experience shows, on the other hand, that this dangerous complication, intestinal adhesion, is rare in uterine fibroid disease, a much less certainly fatal malady than ovarian tumour, a fact to be considered in the estimation of the risks of hysterectomy for fibroids. Most assuredly a very strong factor in the good results of that operation is the rarity of this dangerous form of adhesion. Operators who report their cases should distinguish between true adhesions of the peritoneal surfaces of the intestine and tumour and the adhesion of an extra-peritoneal part of the large intestine to the surface of part of a tumour which burrows under and behind the pelvic peritoneum. The rectum is sometimes united to the tumour in this way ; then it is not always easy to recognise and its longitudinal bands simulate the ureter or may be taken for strands of fibrous tissue belonging to the tumour. Great care is necessary in enucleating the base of a fibroid which burrows deeply. After dividing the pelvic peritoneum too rapid or rough use of the sponge or the finger may result in damage to the rectum, whilst that 6 Large Cystic Myoma of the Uterus of over Twelve Years’ Duration removed by Enucleation; Recovery ; with notes on Cystic Fibroids. Transactions of the Royal Medical and Chirurgical Society, vol. Ixxvi., 1894.