Diagnosis

While lateral displacements of the uterus are not frequent their occasional occurrence must be borne in mind for they may be mistaken for ether conditions. The laterally displaced uterus may retain its form, size and consistence though the conditions causing the displacement, or the results thereof, may alter all of these. If the uterus is uniformly drawn to one side the cervix is of course displaced. If latero-flexed this is not necessarily so, but the fundus will be palpated somewhere between the median line and the lateral wall of the pelvis. This condition will be verified by its absence from its normal position. If a latero-version be present the cervix points away from the side toward which the fundus is directed. Mobility is decreased in either form of lateral displacement.

Various inflammatory conditions may be confusing. Inflammation in the connective tissue lateral to the cervix and uterus will cause an indurated mass of varying size in the pelvis. This induration as a rule is very dense and often extends to the pelvic wall. It is associated with tenderness and usually marked decrease in mobility. If the inflammation is acute, local heat as well as general temperature will be present. There will be a casual history of labor, abortion, cervical injury or an operation about the cervix or uterus. The inflammation may have progressed to abscess formation in which event fluctuation may be detected, depending upon the thickness of the walls surrounding the abscess cavity.

The uterine tube may be inflamed, thickened, nodular, dilated and filled with fluid and involved in peritoneal adhesions. Such a mass usually lies op posite or level with the fundus and is distinct from the uterus. It may be movable unless anchored by adhesions. When the tube is filled with fluid its characteristic sausage shape and fluctuation can be detected. It can often be traced back to the cornua of the uterus and the identity of the uterus determined.

The ovaries when prolapsed or when enlarged from inflammation or the formation of any form of tumor may simulate a latero-flexion. An ovary has a peculiar tenderness giving rise to a peculiar sickening pain on pressure. It is usually movable, but may sometimes be bound down by adhesions. Its size, shape, position, peculiar sensitiveness and consistency are characteristic. When cystic it is soft in consistence but when chronically inflamed it is firm On careful palpation, if not fixed by adhesions, its attachment to the tubo-ovarian region can be determined.

A small uterine fibroid developing between the layers of the broad ligament is attached to the side of and is usually movable with the uterus. Its firm consistence, well defined borders and absence of tenderness will usually make a diagnosis easy. Occasionally a solid tumor of the tube or ovary is found which either because it is intra-ligamentary or is confined to the lower part of the pelvis by adhesions, may resemble a latero-flexion. It is less tender than an inflammatory mass and more definite in outline.

An ovarian or par-ovarian cyst may sometimes develop close to the cervix. They are spherical as a rule and fluctuation can usually be detected.

In all cases of displacement the absence of the uterus from its normal position must be determined as well as its location in an abnormal position.

Treatment

The same general plan of treatment is followed in these cases as will be outlined in the treatment of the more common displacements.

Upward Displacement or the Elevation of the Uterus

This is least frequent of the pathological displacements. It normally occurs with pregnancy as the uterus rises into the abdominal cavity.

The pathological cause are growths below which force the uterus upward or tumors of the ovaries or the uterus, which rise out of the pelvis and draw the uterus upward with them. Occasionally adhesions form during pregnancy, between the abdominal wall and the uterus, so that after the termination of pregnancy the uterus remains suspended by these adhesions from the abdominal wall. Operations involving both the uterus and the abdominal wall may be followed by adhesions which prevent the proper descent of the uterus.

Torsion of the Uterus

This condition is a twisting of the uterus on its long axis. It is usually associated with the more common displacements and is caused by pressure or traction action so as to rotate the uterus on its axis.

The treatment of these unusual displacements will readily suggest itself after a study of the more common ones.