File:Operative gynecology - (1906) (14783217162).jpg

Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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211.—Coronal Section of an Old Atresia of the Vagina with Distention of the Vagina,Cervix, and Uterine Cavity with Menstrual Fluid. The Atresia occupies the LowerThird of the Vagina. but a closer examination showed that they fluctuated and formed a continuouscavity, with two shallow sulci between. The obliterated portion of the vaginawas 4 cm. long. The operation was performed in this way: The left index finger was intro-duced into the 1)1 adder and the thumb into the rectum until they touched thesac of fluid and held the atresic area between their palmar surfaces. Usingthese fingers as a guide to avoid injuring the rectum or the bladder, a large tro- RECTO-VAGINAL FISTULA. 341 car was introduced into the pit beneath the urethra and pushed up through theobliterated septum until it penetrated the sac. Upon withdrawing the trocar500 c.c. (about 16 ounces) of tarry blood escaped and the three sacs collapsed.By means of a uterine dilator the trocar puncture track was now enlarged until
Text Appearing After Image:
Fig. 212.—Old Atresia of the Vagina opened and evacuated; Interrupted Sutures in Place todraw the Vaginal Mucosa down to the Mucosa at the Vaginal Outlet, bridging over theDenuded Area in the Connective Tissue. it reached from one pubic ramus to the other. Abundant room was thus se-cured to catch the margin of the vagina just above the stricture and dissect itloose on all sides for a distance of a centimeter. This loosened collar was thenpulled down over the dilated atresia and attached by a series of interruptedsutures to the margin of the vagina just below it. By this means, by slidingthe normal vaginal tissue down over the cicatricial area, the canal was restoredwithout leaving an exposed raw area to undergo subsequent contraction. Thecaliber of the new vagina was now normal, and a month later, when the patientwas discharged, it even appeared normal in length. If resisting scar tissue is felt after opening up the canal, it must be dis-sected out. Where the urethra is not dilated,

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