Extra-Uterine Gestation—its Early Diagnosis and Treatment.

Abstract

spread by way of the Fallopian tubes to the peritoneum, setting up peritonitis. Or it may be limited to the utero-vaginal canal. Celiotomy is not indicated in lymphatic peritonitis, as the morbid process is too widespread to be reached by operation. Celiotomy has been followed by a fatal result in cases of general puerperal peritonitis. The only ground for advising operation with such a diagnosis is the possibility that this may be erroneous. The prognosis is best when celiotomy is done for localized peritonitis, when the process has become well circumscribed and the element of sepsis eliminated ; in other words, when the case has resolved itself into one of pyosalpinx, abscess of the ovary, or of pelvic abscess of puerperal origin. The prognosis is good when cases of localized peritonitis are operated upon promptly, that is within two or three days of the beginning of the attack, or at about the end of the first week of the puerperium. Cases which have gone from bad to worse, and in which the operation is done as a last resort, usually terminate fatally. Hysterectomy is indicated for those cases in which the infection is limited to the utero-vaginal canal, when, in spite of thorough curettement of the uterus, together with copious irrigation of the utero-vaginal canal, and the employment of proper systemic treatment, the infectious process increases in severity. In dealing with the results of puerperal septicemia by operation, celiotomy affords the opportunity for satisfactory diagnosis and adequate treatment. The organs involved may be palpated or inspected, and when necessary the operation may be followed by irrigation and satisfactory drainage. The vaginal route for operation is indicated for large pus accumulations which are found late in the puerperium. LITERATURE.