Dropsy of the tube may also simulate tubal pregnancy, especially in the abdominal end. With this unfortunate occurrence the uterus and vagina are changed similarly to normal pregnancy, the uterus grows larger and softer. The vaginal portion likewise possesses a marked red appearance, and ordinarily the vagina appears the same as in normal pregnancy; in the breasts you have changes around the nipple and also often secretion. If one has not an opportunity to examine a marked case again and again, so as to appreciate the general growth of the tumor, in many cases it will be found necessary to consider all of the changes in the uterus and vagina, and also the symptoms, to differentiate between extra uterine pregnancy, hydrops tubm and other tumors. Tubal pregnancy is unilateral while hydrops tube is usually bilateral; by this Kiwisch has made a positive diagnosis from a single examination.
Differentiation is also necessary from remnants of pelvic peritonitis (vide Fig. 6). The catarrhal secretion in the tube is easily changed to pus by infection, which may result from a simple examination, more especially from an intrauterine, when strict antisepsis is not resorted to.
Inflammation of the tube ingitis) usually follows acute diseases of the uterus and its surroundings. The more severe forms belong to the puerperal period.
Marked symptoms are caused when tumors or new formations in the uterus or its neighborhood become inflamed. We have seen severe in flammation of the tubes in decomposing fibromata of the uterus. Hennig saw it accompany carcinoma of the uterus. It is often a catarrhal pro cess, affecting the entire thickness of the wall, and there is a marked pro duction of pus. The mucous membrane is more or less reddened and swollen according to the intensity of the inflammation. The deposit can be stripped off and is similar to a croupous membrane, or ichorous pus • may have formed, and often diphtheritic ulceration is present.
The inflammation may extend to the peritoneal covering (perisal pingitis), to the ovaries (perioophoritis), also to the pelvic peritoneum (pelvic peritonitis) and often to the general peritoneum, as especially de scribed by Forster, Buhl, Hecker and others. In many cases we find inflammation of the structures in the neighborhood of the displaced ostium abdominale, the fimbrim assume the most peculiar shapes, become agglutinated one with the lateral ligament, one with the ovary, to the left with the sigmoid flexure, to the right with the colon; or the ostium inverts itself and its peritoneal surfaces grow together (glob), or even one tubal end becomes adherent to the other. By these adhesions the
ostium abdominale becomes closed and an accumulation of pus in the tube takes place, to which occurrence is given the name of pyosalpinx or tubal abscess. Hennig's two cases should be so recognized whether the accumulation of pus was as above-described or in the wall of the organ.
Pyosalpinx, as it has been described, may develop in two different manners: (1) a chronic process causes a hydrops tubm, which is changed to pus by acute inflammation; (2) it can be rapidly produced by an acute process.
Course and Development.—The accumulation of pus in the tubes is always to be looked upon as serious, while the bursting of a pus-contain ing tube-sac usually causes a fatal peritonitis. The pus will either escape through the natural contracted openings of the tubes or through a per foration.
This result can often bring about a very sudden unforeseen danger to the patients. Once we attended a necropsy on a woman suffering from carcinoma, who suddenly died from the bursting of a pus-containing tube, and a consequent peritonitis; a very interesting example has been described in Frankenhisuser's clinic.
It is more dangerous for a pyosalpinx to empty itself into the ab dominal cavity than to become adherent to the neighboring organs and empty itself into them. A not infrequent occurrence is for a pus-con taining tube-sac to perforate into a pseudo-membranous encapsulated pus centre. Under such circumstances, after a long existence, it may even end in a favorable way by fatty degeneration, calcareous degenera tion (glob), absorption, or later these pus cavities may rupture into the free abdominal cavity, or into neighboring organs.
41 A noteworthy example has been described by Kiwisch. A patient in Andral's clinic aged thirty-seven years, who gave birth without trouble to her last child seventeen years ago, for three months had been sick without apparent cause. The most prominent symptoms were constipa tion, pain in the lower part of the abdomen, occasional vomiting and colic. In August a sudden pain appeared in the left side, and the patient noticed that a swelling was forming in the groin, which was accompanied by a numbness in the left leg. In September was found a very tender deep-seated swelling about the size of a small dinner-plate. Vomiting and colic became continuous, and degeneration of the ovary with peritonitis was diagnosticated. Later obstipation and diarrhoea set in, and during October it became bloody, causing rapid loss of strength, so that on Octo ber 9th a severe colic was followed by death.