HEMORRHAGE INTO THE TUBES.
Severe grades of hemorrhage into the tubes are rare and occur in and under the mucous membrane (apoplexia fuixtrum); smaller extravasations are also found in these organs, and occasionally may be seen where death has occurred from cholera, typhus fever, small-pox, puerpera and puerperal diseases.
Rokitansky believes that it often comes from bursting of weak blood vessels, and that the discharge of blood is due to disturbed circulation of the upper organs of the body, as in pleuritis and hepatitis. Blob often found escape of blood in inflammation of the tubes. These small accumu lations of blood give rise to no symptoms and are of no practical impor tance. When the patients do not succumb to the hemorrhage it is absorbed without leasing a trace. There are also described cases of bleed ing of the mucous membrane of the tubes that were fatal. Kiwisch has questioned if these fatal hemorrhages are not due to early tubal pregnancy.
Marked congested conditions of the pelvic organs and inflammation and swelling of the mucous membrane of the tubes, may cause a large accumulation of blood on the surface of the mucous membrane, especially at the abdominal end, from which it escapes and forms a cellular hema toma.
Large collections of blood in the Fallopian tubes (hematosalpinx) are of great practical importance. On this account we will more extensively consider these diseases.
lleniatosalpinx.—Etiology.—Even as closure of one or both tubal extremities may cause hydrosalpinx, so, under similar circumstances, in case of marked congestion of the mucous membrane, may we have hema tosalpinx; or an apoplectic centre in the tube breaks through the mucous membrane, and so also a hematosalpinx is formed. In the same manner accumulations of blood in the tube may be caused by adhesions of the tube to the ovary. Kiwisch and others have found accumulations of blood in a rudimentary tube in a case of absence of the uterus.
These rare causes of hematosalpinx are opposed to the cases where, by closure of the genital canal in any one place, large quantities of blood accumulate. After what has been said, long-standing hematometra and also hematoelytron are the principal causes of the formation of blood containing tube-sacs. In most of the already mentioned cases the uterus was bicornate, and one side of the double genital canal was closed at a higher or lower point. The higher the atresia in the utero-vaginal pas
sage the sooner a hematosalpinx will be formed. In very deep atresia, or atresia hymenalis, hematosalpinx is rarely observed; the earlier the diagnosis is made in these complaints the better can the disease be treated. But also in a case of atresia hymenalis, according to Hennig's researches, tubal sacs have formed; so it was in a case of Merchant and Mosse, who, after an operation for atresia followed by death, found that the outer part of the tube was distended with blood, which by pressure had trickled out into the abdominal cavity and caused inflammation. Under similar treat ment a patient of Th. Paget died seven days after the operation, probably on account of the bursting of the sac.
It is not certain whence the blood comes, whether from the uterus, the ovary, or from the inner surface of the tubes.
In cases where the upper portion of a blood-containing tube-sac is near the ovary, it is always possible that the blood has escaped from a burst follicle. In most cases the sacs are found not connected with the ovaries, and in a large number of these cases the blood-sacs of the tubes were entirely separated from the blood contained in the other part of the genital canal, or were connected to it by means of a narrow passage often times a number of lines in length. Therefore we believe, although in our own following observed case the uterine end of the tube was found wide open, that the blood of hematosalpinx originates from the inner surface of the Fallopian tube; this idea has already been advanced by Rose. When menstrual blood is prevented from escaping from the Fallopian tube the origin of hematosalpinx is explained. We believe that in most cases, with the menstrual process, blood escapes from the mucous membrane of the tube, and that during menstruation the uterine ostia are softened with the entire organ and permit blood to flow regularly into the uterus. If by marked obstruction the flow of blood from the uterus is prevented, it is dammed back in the tubes; in the following preparation, between the hematometra and hematosalpinx is situated the hypertrophied uterine body and an hypertrophied tube three inches long; but at any time the regular flow of blood from the tube into the uterus may be prevented and form a hwmatosalpinx.