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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arranged under two car-dinal divisions—prolapse of the entire uterus, and prolapse of the cervix only. In the first case the uterus descends as a whole, the fundus sinking paripassu with the cervix, following it out as it passes beyond the vaginal outlet;in its descent the uterus occupies an infinite number of positions between thenormal anteflexion, and a condition of complete extrusion. In the second case the fundus of the uterus descends but slightly in thepelvis, while the cervix, advancing more rapidly, escapes at the outlet, withthe everting vaginal walls; this form of prolapse involves only the lower ex-tremity of the uterus and is therefore incomplete. A good illustration of the elongation of the cervix just above thevaginal vault is afforded by the relations of the parts in one of my patients. 619 620 PROLAPSE OF THE UTERUS. Here there was a little atrophic cervix at the end of a prolapsus hanging 7 cm.(3 inches) below the vulva. The sac was but 10 cm. (4 inches) in circum-
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Fig. 352.—Complete Prolapsus of the Uterus and Vagina, forming a Large MucousPouch Eroded in Dark Areas. The patient, a negress, is seen from behind, in order to expose the sac better. ferenee. The length of the uterine canal was 11 cm. (4-J inches), and the bodyof the uterus lay entirely within the pelvis. A diverticulum of the bladder FORMS OF PROLAPSE. 621 entered 3; cm. (1-; inches) into the sac, while the rest of the bladder extended9 cm. (3£ inches) up into the pelvis. On returning the sac, nothing wasapparent but a relaxed outlet and a cystocele of moderate size. This remarkable displacement owes its occurrence to a ductile conditionof the supravaginal portion of the cervix, where it joins the uterine body,allowing it to be drawn out from 3 to 6 cm. (1 to 2^ inches) longer thannormal. Variations of these two cardinal divisions of prolapse are formed by thepresence of a longer or shorter bladder diverticulum, or even by the absence ofany portion of the bladder within the sac.

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