ABNORMAL COMMUNICATIONS WITH TIIE UTERUS.
The uterus may open into the cloaca.; this has been seen in the new born, but not in adults. Thus, J. F. A. Wolff describes a ease in which the double uterus opened by a vagina duplex into the common excretory duct of the genital, intestinal, and urinary passages.
More frequently observed are communications between the uterus and the urinary organs, especially as a combination of abdominal, vesical and symphyseal fissure. Most often it is in dead-born infants, but it has been often seen in adults; the connection with the misshapen urinary organs being by means of a short vagina. In spite of the malformation, conception may set in, but abortion easily occurs. This is supposed to be because the uterus, deprived of its supports, sinks down into the vagina, and thus by tension upon the lower segment of the womb awakens uterine contractions. It is almost always necessary to employ artificial means for delivery. The diagnosis is easy on account of the superficial nature of the anomaly.
Dyhrenfurth has described a peculiar case: In a girl twenty-two years old, who had menstruated regularly for six years, cohabitation could not be effected. The vagina was found closed, the uterus rudimentary. Menstrual blood flowed per urethram. On dilating the urethra, no connection with the uterus was found; and the cherry-sized uterus rendered it probable that there was a true vicarious menstruation.
Communications of the uterus with the rectum are much rarer. In birds the genital canal normally opens into the rectum. Conception may occur here, in spite of the closure of the external genitals. The cases of Rossi and Louis are well known, and have often been cited.
In Rossi's case the rectum communicated with the vagina by a little opening above the sphincter ani. The vagina itself was closed save for a fine canal. Impregnation took place per rectum. Delivery was effected at term by division of the septum occluding the vagina. The woman later conceived again through the artificial vagina.
In Louis's case the external genitals were closed; menstruation was per rectum; cohabitation per anum. Conception occurred, and the child was delivered by the rectum.
Rectal examination is called for, and will immediately reveal the true state of affairs.
The treatment during delivery is that which Rossi practised, especially when the recto-vaginal opening is small.
We must mention an extremely interesting case observed at the sur gical clinic at Kiel, and described by II. Becker as a case of " atresia ani uterina." The external genitals of a new-born child showed only a single open ing for the urethra; the anus was imperforate. While operating for this. a sac was reached 1.4 inches up, which was supposed to be the rectum; a. small arnount of turbid fluid was evacuated. A few days later an autopsy was held. There was a double uterus, the single vagina of which opened into the urethra. The right uterine cavity was closed to the vagina. The left had not only an opening into the vagina, but also a short canal lead ing to the rectum, which ended high up in the pelvis. The left half of the uterus bad been opened in place of the rectum.
Only two similar cases are recorded: Bednar's and Vallisnieri's. In the first the rectum communicated with a simple, in the latter with a duplex uterus.