HEMATOCELE ANTE-UTERINA..
Under this name we understand a blood-tumor which has formed in the vesico-uterine excavation. This by no means occurs under such con stant relationship as does retro-uterine hematocele, and does not form nearly so typical a picture of disease. It is, as SchrOder says, most often a part of other diseases; and it has been so rarely observed that the his tory of the recorded cases may perhaps give us some idea of its mode of origin.
In the first cases which came to post-mortem examination it was in connection with large retro-uterine hematocele (Martin, Magron and Soulie), and the tumor formed of the blood which flowed over the uterus did not form a projection which was perceptible externally.
In a second case, by G. Braun, the woman was thirty-five years old, and had had two children, the last nine years ago. Pains set in, and a tumor six inches long appeared in front of the uterus, displacing the blad der to the right, and filling the anterior vaginal vault. An exploratory puncture was made in the anterior vaginal vault, and the bloody contents of the tumor were evacuated with a Dieulafoy aspirator. Four days later the woman died. The autopsy showed the existence of peritonitis; at the place of the tumor was a sac as large as a child's head, the walls of which posteriorly and below were the broad ligament and the uterus, and to the left the sigmoid flexure, anteriorly and above adherent coils of small in testine the great omentum, and the bladder.
In a further case, related by C. Schroder, the ante-uterine blood-tumor was an occurrence in a tubal pregnancy, and had happened from a rent of the sac. The woman was thirty-three years old, had had one child three years before; the autopsy revealed a large intra-peritoneal ante uterine mass of blood, which extended to the region of the external os uteri. During life it formed a plainly distinguishable ante • uterine tumor, composed of non-encapsulated, simply coagulated blood. The uterus was attached to the rectum by numerous broad fibrinous bands, so that there was no recto-uterine excavation. Schroder considered the posterior dis placement of the uterus not as due to the formation of the ante-uterine hematocele, but as the condition necessary for the formation of the latter, forming a space analogous to Douglas's cul-de-sac, in front of the uterus. It is probable, in Schroder's opinion, that when the posterior cul-de-sac is destroyed, the anterior one enlarges.
As to the danger of confounding ante-uterine hematocele with lateral hematometra and hematokolpos, we have already spoken of this under the subject of differential diagnosis.