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Bilateral simultaneous tubal pregnancy
904
AMJZZICAN
Jt'XJR~KAL
OF
OBSTETEICS
AND
GYNE,COLOGY
patency. Here again, however, it is conceivable that inspissation or encapsulation of the oil within or about the tubes may occur and thus defeat the purpose for which it was introduced. From the experience with the extrauterine pregnancy here reported, the author concludes that the uterotubal injection of iodized oil is not entirely harmless. It appears that the oil is not only slowly absorbed and may, by remaining in the tubes for as long as two years, retard the advent of pregnancy, but such delay in absorption may be also a factor in the development of extrauterine pregnancies. In the case here reported, it is conceivable that the oil became encapsulated at the right fimbriated end, and thus did not permit the impregnated ovum to reach its normal place of nidation within the uterus. J. THORNWELL WITHERSPOON. Hoffman, A. I.: Complete Tubal Abortion From Columnar Implantation of the Ovum, GynBc. et obst. 33: 520, 1936. Upon the site of implantation of the ovum depends the mode of termination of a, tubal pregnancy. Xost frequently it terminates by tubal abortion, in which ease the ovum is usually in the ampullar portion of the tube. If situated in the isthmus tubal rupture occurs. In complete tubal abortion, which is uncommon, the entire ovum is expelled, and if there is no marked alteration of the tubal musculature the tube contracts with arrest of hemorrhage, and involution follows. Implantation of the ovum in the ampulla may occur on the summit of a plioal fold. Werth termed this I LColumnar Implantation” as distinguished from “Intercolumnar Implantation ’ ’ with implantation between the plicae. In the former the muscle wall remains intact or almost so for five or six weeks, particularly if the ovum succumbs early. The ovum thus suspended in the lumen of the tube by a pedicle consisting of the plica is swept by reverse peristalsis into the abdomen. Clinically, complete tubal abortion is characterized by delay in menstruation, sud. den onset of abdominal pain, and signs of internal hemorrhage and shock. From his personal experienee with three patients presenting this condition the author stresses several important operative findings. There is massive peritoneal hemorrhage with the source of bleeding not apparent. The affected tube is markedly hyperemic and the ampullar portion, in contrast to the isthmus, is somewhat dilated. He suggests that the tube be gently compressed between two fingers and milked from the isthmus toward the ab,dominal ostium; this will express the small black blood clots that remain within the tube after complete expulsion of the ovum. In reference to treatment he advises salpingectomy for the following reasons: (1) Hemorrhage may recur from site of detachment of ovum; (2) trophoblastic elements which are present in considerable quantity may give rise to hemorrhage as an immediate complication, or to placental mole or chorionepithelioma as a late complication; (3) the adected tube though involuted remains a potential site for another ectopic gestation. ARNOLD GOLDBERGER. Paola, Guillexmo Di, and Ibanez, Anibal Lemos: Bilateral Simultaneous Tubal Pregnancy, Bol. Sot. de Obst. y ginec. (Buenos Aires) 14: 837,1936. The authors present a case of bilateral tubal pregnancy. They state that in the literature they could find only 4 such cases heretofore mentioned. The theories for such an occurrence are as follows: (1) Fecundation of 2 ova from distinct follicles in the same ovary; (2) Fecundation of 2 ova from different ,follicles of both ovaries; (3) Fecundation of 2 ova belonging to the same follicle. The treatment was salpingeetomy, bilateral in this case, as both tubes were involved. MARIO A. CBSTALLC.
AMJZZICAN
Jt'XJR~KAL
OF
OBSTETEICS
AND
GYNE,COLOGY
patency. Here again, however, it is conceivable that inspissation or encapsulation of the oil within or about the tubes may occur and thus defeat the purpose for which it was introduced. From the experience with the extrauterine pregnancy here reported, the author concludes that the uterotubal injection of iodized oil is not entirely harmless. It appears that the oil is not only slowly absorbed and may, by remaining in the tubes for as long as two years, retard the advent of pregnancy, but such delay in absorption may be also a factor in the development of extrauterine pregnancies. In the case here reported, it is conceivable that the oil became encapsulated at the right fimbriated end, and thus did not permit the impregnated ovum to reach its normal place of nidation within the uterus. J. THORNWELL WITHERSPOON. Hoffman, A. I.: Complete Tubal Abortion From Columnar Implantation of the Ovum, GynBc. et obst. 33: 520, 1936. Upon the site of implantation of the ovum depends the mode of termination of a, tubal pregnancy. Xost frequently it terminates by tubal abortion, in which ease the ovum is usually in the ampullar portion of the tube. If situated in the isthmus tubal rupture occurs. In complete tubal abortion, which is uncommon, the entire ovum is expelled, and if there is no marked alteration of the tubal musculature the tube contracts with arrest of hemorrhage, and involution follows. Implantation of the ovum in the ampulla may occur on the summit of a plioal fold. Werth termed this I LColumnar Implantation” as distinguished from “Intercolumnar Implantation ’ ’ with implantation between the plicae. In the former the muscle wall remains intact or almost so for five or six weeks, particularly if the ovum succumbs early. The ovum thus suspended in the lumen of the tube by a pedicle consisting of the plica is swept by reverse peristalsis into the abdomen. Clinically, complete tubal abortion is characterized by delay in menstruation, sud. den onset of abdominal pain, and signs of internal hemorrhage and shock. From his personal experienee with three patients presenting this condition the author stresses several important operative findings. There is massive peritoneal hemorrhage with the source of bleeding not apparent. The affected tube is markedly hyperemic and the ampullar portion, in contrast to the isthmus, is somewhat dilated. He suggests that the tube be gently compressed between two fingers and milked from the isthmus toward the ab,dominal ostium; this will express the small black blood clots that remain within the tube after complete expulsion of the ovum. In reference to treatment he advises salpingectomy for the following reasons: (1) Hemorrhage may recur from site of detachment of ovum; (2) trophoblastic elements which are present in considerable quantity may give rise to hemorrhage as an immediate complication, or to placental mole or chorionepithelioma as a late complication; (3) the adected tube though involuted remains a potential site for another ectopic gestation. ARNOLD GOLDBERGER. Paola, Guillexmo Di, and Ibanez, Anibal Lemos: Bilateral Simultaneous Tubal Pregnancy, Bol. Sot. de Obst. y ginec. (Buenos Aires) 14: 837,1936. The authors present a case of bilateral tubal pregnancy. They state that in the literature they could find only 4 such cases heretofore mentioned. The theories for such an occurrence are as follows: (1) Fecundation of 2 ova from distinct follicles in the same ovary; (2) Fecundation of 2 ova from different ,follicles of both ovaries; (3) Fecundation of 2 ova belonging to the same follicle. The treatment was salpingeetomy, bilateral in this case, as both tubes were involved. MARIO A. CBSTALLC.