Two cases of laparo-elytrotomy : with remarks / by Charles Jewett.

  • Jewett, Charles, 1839-1910.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of laparo-elytrotomy : with remarks / by Charles Jewett. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    in enlarging the vaginal wound. The margin of the vesico- vaginal junction should he defined by means of a staff held in the bladder. The rent should be carefully limited ante- riorly, and should be carried backward as far as possible with- out invading the pouch of Douglas. I see no reason why the rent could not be carried across the posterior vaginal wall by first lifting the utero-sacral fold of peritoneum. Much space might thus be gained, and the danger of injuring the bladder before or during the extraction be greatly dimin- ished. During the delivery, as a still further precaution, let an assistant hold his finger at the vesico-vaginal junction in front of the wound to give warning of approaching danger. By thus utilizing all the available space, by extending the vaginal opening with the utmost caution, and by guarding its anterior limit during delivery, vesical injuries, I am sure, would be very rare. The importance of this complication is, however, as Dr. Skene has said, somewhat diminished by the fact that in all cases thus far, with a single exception, the bladder wound has closed by spontaneous union. And it occurs to me, in view of the tendency to spontaneous closure, as well as the difficulty and added danger of immediate suture, that the immediate closure of the wound by surgical interference, as suggested by Dr. Garrigues, is not called for in mere vesico- vaginal rents. In one of the foregoing cases the child was extracted below the ureter, and in the other above it. They demon- strate the feasibility of delivery by either method. Extrac- tion below the ureter, I believe, best protects it from inju- rious pressure or tension, though possibly open to objection from the disturbance of its anatomical relations. In which- ever way delivery is accomplished, it is more satisfactory to identify the ureter in the course of the dissection. That the ureter can be readily identified I am convinced from my experience in the first case, and from observations upon a post-mortem delivery by laparo-elytrotomy, reported by Dr. B. F. Westbrook, and which I had the privilege of witnessing.