Adenomyoma or endometrial implants in the abdominal wall

NI

w SERIES

Vol.. II, No. i

Pi-ogress in Surgery

1. Genera1 ptosis of the abdominal viscera, kidnev and uretera stones are not contraindicitions for the operation. infections in the ptosed kidney 5. Persistent are frequentIy cured by a nephropexy which wiII keep the ureter straight enough to drain its contents. SCHOLL, A. J., Los AngeIes. HistoIogy and mortality in tumors of the prostate, bIadder, and kidney. C&j. pes with corresponding degrees of malignancy. The aIveoIar carcinoma group is a small one; the tumor, which is highIy maIignant, tends to reproduce the tubuIes of the aduIt kidney. The difIicuIty or ease of surgical remova of tumors must be considered a most important factor in regard to prognosis regardIess of the inherent malignancy of any tumor. PHATT, J. P., Detroit. Adenomyoma or endometria1 impIants in the abdomina1 waI1. J. .\fich. State M. Sot., Feb., 1927, xxvi, 82. Implantation of endometria1 tissue in a Iapnrotomy scar is not uncommon. Forty-two cases are reviewed and four new cases added. It follows, more frequentIy, an operation in which normal endometrium has been trau-

American

Journal

of Surgery

401

matized. VentraI fixation is the most common type of operation preceding scar impIantation. SpeciaI care shouId be used during this operation not to penetrate the endometrium. AIthough the growth in the scar was not encapsuIated IocaI excision was sufficient. Two cases of incomptete removal recurred. A seconcl operation reIieved both of these. AI1 IocaI symptoms have been reIieved by remova of the growth. RegardIess of the cause of other enclometria1 growths this group seems to be clue to implantation. COLLINS, CLIFFORD U., Peoria, III. myomas of the rectovagina1 septum. -44. J., Feb., 1927, Ii, 128.

AdenoZllinois

Sampson’s theory that these tumors are caused by the escape of endometria1 ceIIs through a patent faIIopian tube is being generaIIy accepted by pathoIogists and gynecologists. These tumors are found only in women during the menstrua1 period of their Iives, ancI the majority of the patients have not been pregnant or severa years have eIapsed since the birth of a chiId. Graves reported three cases of adenomyoma in the rectovaginal septum in which he removed the uterus with the ovaries, but did nothing to the tumor, which compIeteIy disappeared in two cases and had practicaIIy disappeared in the third case. As more cases have been reported it is generaIIy conceded now that the compIete removal of the ovaries wiI1 cause the tumors to cease to grow and wiI1 probabIy cause them to disappear. It wouId simplify the operative procedure very much if it was necessary onIy to remove the ovaries and Ieave the tumor aIonc, because it is very cIiff~cuIt to remove the tumor compIeteIy. No examination of a tumor in the rectovagina1 septum is complete unIess the examining tinger is passed into the rectum. In the remova of these tumors a great dea1 of attention must be paid to hemostasis as these patients have a tendency to bleed free&during and after the operation. If an accidental or deIiberate opening is made in the rectum, the drainage material should not be gauze or stiff rubber, but soft rubber dam, and the rubber dam shouId not bc placed on the suture line. A great many more cases must be reported before definite concIusions can be made as to the proper treatment. UntiI definite conclusions