UTERINE ADNEXA, DISEASES OF. Malformations of the Ovaries and Tubes.
Malformations of the ovary and tube may be congenital or acquired. Both ovaries may be congenitally absent. This malformation is generally associated with defective development of the uterus. An individual so affected does not experi ence the physical changes in conforma tion incident to puberty, and more re sembles the male. If one ovary is absent, the corresponding half of the uterus and tube will probably be deficient in de velopment. The corresponding kidney has also been found absent. A third or accessory ovary is very infrequent. Con stricted portions of the ovary have been mistaken for supernumerary ovaries. Small islands of ovarian tissue have been found upon the peritoneum. Such con ditions, or an incomplete removal of an ovary, are undoubtedly the causes of menstruation subsequent to oophorec tomy. With absent or partially devel oped ovaries the sexual functions are never performed normally. The absence of one ovary or its destruction 1w dis ease constitutes no obstacle to either sexual intercourse or conception. It is very important to determine the absence or existence of rudimentary ovaries, as, when once recognized, the futility of measures to establish menstruation is demonstrated.
Defective development in the tubes consists generally in defective develop ment of the fimbria3 at their abdominal ends. The tube may be unusually short or well developed on one side and rudi mentary upon the other. The most fre quent alteration is in the supernumerary ostia, or openings of the tube. These may be mere apertures or surrou nded by fimbrire. A defective development may result in an unusually convoluted tube. These convolutions may be so marked as to form strictures which con tract the cavity sufficiently to render the woman sterile. In failure of the ovary to descend, the tube may be drawn out at the higher level.
Acquired Malformations of the Ovaries and Tubes.
The acquired malformations of the ovary and tube are frequently produced by disturbances in the circulation. They result in hyperremia, or congestion, of the ovary. This occurs physiologically
during ovulation and coition. It is not infrequent at the establishment of the menstrual function, especially in those individuals in whom the mental faculties have been developed at the expense of the physical structure.
Marked congestion may result in ex travasation of blood into the follicles and stroma of the ovary, more frequently in the former. Such a hannorrhage may had to the follicles being distended to the size of a hen's egg or even that of an orange. This is later converted into a pigment of the consistence of honey, with a chocolate color. Such conditions have also been associated with heart dis ease, typhoid fever, phosphorus poison ing, and in excessive burns. Follicular apoplexy, as well as ovarian congestion, mostly occurs in the sexually immature. Such a collection may be absorbed, or the distension become so great as to cause rupture of the ovary and a large hmmorrhage into the peritoneal cavity. Occasionally a fatal peritonitis may fol low.
The tube my undergo alterations in form and situation, while the presence of abdominal tumors, especially ovarian tumors, stretch the tube out, causing it sometimes to attain two or three times its normal length. The tube may be come congested from being twisted with the pedicle of a cyst. Moderate conges tion results simply in the distension of the tube; more marked interference with the circulation will result in the rupture of small vessels and extravasa tion of blood into the tube and the sur rounding parts. If still more marked, may lead to necrosis of the tube with the tumor. Congestion of the ovary and the tube is characterized by pain in the lat eral region of the pelvis preceding the menstrual flow by a week or ten days. With the establishment of the flow the engorgement will be relieved, the pain ceases, and many patients experience greater comfort during the menstrual period. The flow is generally prolonged and excessive, not infrequently amounts to haemorrhage. The patient is weak, pale, and anxinie.