This section is from the book "Applied Anatomy: The Construction Of The Human Body", by Gwilym G. Davis. Also available from Amazon: Applied anatomy: The construction of the human body.
hysterectomy, - removal of the ovary, - oophorectomy, - removal of the Fallopian tubes, - salpingectomy. The ovaries are often removed with the diseased tubes and also in cases of hysterectomy. These operations are usually done through an abdominal incision near the median line between the umbilicus and the symphysis pubis. Not infrequently they are done through the vagina. After the abdomen is opened it is important to be able to recognize and isolate the individual organs, this is much facilitated by elevating the pelvis so that the intestines gravitate toward the diaphragm - Trendelenburg's position (Fig. 463). The incision having been made and the abdomen opened the first structure seen is the great omentum. This often extends as low as the symphysis. As it hangs from the transverse colon it is to be displaced upward and not toward the sides. The next structures exposed are either the small or large intestines. The transverse colon normally should not come below the umbilicus but it often does come lower and may even descend to the level of the symphysis. When it is low it lies in front with the small intestines behind. It likewise should be displaced upward. Sometimes the sigmoid colon may make its appearance from the left and more rarely the caecum from the right. It should not be forgotten that both these structures are bound to the posterior abdominal walls and may often be covered in front by coils of small intestine. Quite frequently however, the caecum on the right and iliac colon on the left come in contact with the anterior abdominal walls in the iliac fossa in the neighborhood of the anterior iliac spines and may extend part way down Poupart's ligament. The sigmoid colon if distended may bulge anteriorly but more usually it lies posteriorly covered by the small intestines. If it or the caecum are encountered they are to be pushed upward and to the side. The small intestines are to be displaced upwards. In the median line anteriorly is now seen the bladder and directly behind it the uterus. If the uterus is drawn to one side the broad ligament of the opposite side is made tense and the round ligament is seen running to the internal ring anteriorly and, more posteriorly, the Fallopian tube. On the posterior surface of the broad ligament below the outer end of the Fallopian tube is seen the ovary. Farther posteriorly, in the hollow of the sacrum, is the rectum, with Douglas's pouch between it and the uterus in front. If it is desired to recognize the structures by touch instead of sight then the anterior abdominal wall is followed down over the bladder and the fundus of the uterus recognized as a hard rounded mass. This can be grasped between the thumb and fingers and followed laterally past the cornu to the broad ligaments. If the tubes and ovaries are enlarged they may be found lying posterior to the uterus in Douglas's pouch instead of laterally.
Fig. 463. - View of the interior of the female pelvis in the Trendelenburg position.