Fallopian tube

“ There are many who manifest a laudable desire to understand the physiology of conception, the changes which take place, and the order of their natural occurrence. When impregnation takes place at the ovaries or within the Fallopian tubes, there is exuded upon the inner surface of the womb a peculiar nutritious substance. It flows out of the minute porous openings surrounding the termination of the Fallopian tube within [pg 216] the uterine cavity, and, thus, is in readiness to receive the germ, and retain it there until it becomes attached. ”

“ Sometimes the sperm cell from the male comes up into the tube to meet the egg and it is fertilized here. The union of the two cells usually occurs in the outer end of the fallopian tube; but this is not the nest nature has prepared for the egg's development, and unless it returns into the uterus it causes serious trouble and an operation is necessary. Impregnation in the tube is very rare, but it is possible.
The uterus, often spoken of as the womb, is a hollow muscular organ into which the egg comes from the tubes to be fertilized—four to eight days from ovaries to uterus. ”

“ The membrane in contact with the parietes of the cavity is pulpy—the other membranes are better weaved and clothy. The cavity itself seems to occupy nearly the entire volume of the ovarium, which is enlarged to nearly four times the size of the right ovarium. The fallopian tube corresponding to the enlarged ovarium, is not in the least involved in that enlargement, although it is adhering to the periphery of its ovarium by a portion of the fimbriated end,—the fimbriæ, however, being left free. We have neither disease nor enlargement in the ovarium and fallopian tube of the right side. ”

“ In diagnosing the cause of sterility, in determining whether in any particular instance it is due to some hindrance to the indispensable conjugation between the male and female reproductive elements, we have in the first place to ascertain the presence or absence of any of the numerous conditions which interfere with the proper passage of the ovum from the ovary through the Fallopian tube to the interior of the uterus. The simpler mechanical hindrances to conception, such as displacements of the uterus, or tumours of that organ or its annexa, are easily recognized ”

“ When the endometrium is septic or cancerous both ovaries and tubes should be removed. When the surgeon decides to leave an ovary and its corresponding Fallopian tube, he should take care in securing the ligatures to include the ligament of the ovary: it is very liable to slip out of the encircling loop of silk. It is often convenient to include the round ligament of the uterus in the pedicle, but it is not a disadvantage when it is tied separately. ”

“ If the patient is anxious for children, the operator should remember that conception is possible with one tube and one ovary, though they be on opposite sides. If an ovarian tumor is removed independently of the corresponding Fallopian tube, the pedicle of the ovary should be transfixed and ligatured in two or more masses. ”

“ It is now known that fertilization of the human ovum by the spermatozoon may take place even when the ovum is in its follicle in the ovary, for oosperms have been found in the ovary and Fallopian tubes as well as in the uterus. Belief in ovarian pregnancy is of old standing, and had been regarded as possible but unproved, no case of an early embryo in its membranes in the sac of an ovary being forthcoming, until the remarkable case published by Dr Catherine van Tussenboek of Amsterdam in 1899 (Bland-Sutton) . Tubal pregnancy is most frequent in the left tube ”

“ OF EXTRA-UTERINE CONCEPTION. It sometimes happens, that instead of the impregnated ovum passing into the womb, it is either retained 282in the ovarium, [463] or it stops in the fallopian tube, or it misses the tube and falls amongst the bowels. Of these, the tubal is by far more frequent than the ventral conception. We learn from the numerous cases which are recorded of extra-uterine pregnancy, that it may terminate in several different ways; in some cases sudden death occurs from hemorrhage; [464] in others, the unfortunate woman survives for a long period ”

“ Fecundation or conjugation takes place most often in the Fallopian tube, sometimes in the uterus. The maturation and expulsion of the ovule are generally accompanied in women by a nervous phenomenon closely related to erection in man. The mucous membrane of the cavity of the uterus is very rich in blood vessels which become dilated and gorged with blood under the inhibitory influence of certain nerve centers. As the mucous membrane is very thin, the result is otherwise than in man; the blood transudes through the mucous membrane and flows away. ”

“ It can be seen that the function and vitality of the ovaries are in no way affected by the tubes. The ovarian function goes on, whether the tubes perform their function of conveyance or not, and if this function can be destroyed, life-long sterility is assured. There is no abdominal operation more simple, rapid and safe, than simple ligature of the Fallopian tubes. ”

“ While the process or metamorphosis of the ovulum noticed by Boer takes place in the ovarium, in consequence of fecundation, the cavity of the womb does not remain idle, but forthwith sets about weaving for itself a general lining—a sort of pseudo-textile membrane—which extends all over the cavity, descends partly into the cervix, and is often, (not necessarily always,) projected even into a great portion of the fallopian tubes. ”

“ In the meantime, Steve and I were doing it like bunnies and still no pregnancy.
Okay, she then declared, the problem may be with your Fallopian tubes after all. Time to test for abnormalities. "This is not going to be fun. First we have to dilate your cervix, after which we inject a dye and follow it with X-rays as it moves through the uterus and is ejected out of your Fallopian tubes. We'll know right away if there's any kind of blockage. If there is something, we can go in and fix it."
"Sort of check out my pipes," I said, trying to come to grips with the procedure. ”

“ If the Fallopian tubes and ovaries are displaced, which is frequently the case under these circumstances, they are bound more or less firmly in the abnormal position. The adhesions are sometimes extremely delicate, and embrace the displaced organs as a net. At other times, or later, they may be so large and firm as to be readily felt through the vagina. Again, the false membranes may be broad and ribbon-like, and occupy a position so as to imprison the displaced organs as though elastic bands were stretched from the anterior to the posterior portion of the pelvic brim. ”

“ On the other hand, some women, knowing the risks, ask that steps may be taken to prevent a recurrence of what they consider a catastrophe. This appears a simple matter, but it is not so in reality, for in many instances in which the operator had been under the impression that he had effected this by ligature of both Fallopian tubes in continuity, he has been surprised when the woman has again come under his notice well advanced in pregnancy. ”

“ The Fallopian tubes, which penetrate and are attached to the peritoneal sack, together with the uterine broad ligaments, are designed to hold the womb in place, but if the womb and ovaries are crowded down into the pelvic cavity and the womb doubled upon itself, dysmenorrhea or painful menstruation, or amenorrhea, with convulsions, is the result. Perhaps there may even be a complete stoppage, so that Nature menstruates vicariously and casts it off through the lungs or bowels. ”

“ In association with absence or a rudimentary condition of the uterus, the vagina also may be wanting, or may be represented merely by a small, blind pouch; the Fallopian tubes may in such cases either be normally developed or rudimentary. The number of instances of this kind that have been observed is very large (Kussmaul, Klebs, Cusco, Klinkosch-Hill, Cruise, Freund, Fürst, Engel, Gusserow, Nega, Kiwisch, Rokitansky, Braid, Jackson, Lucas, Duplay, Dupuytren, Renaudin, Crédé, Saexinger, and many others) . ”

“ To spare a woman a recurrence of tubal pregnancy it has been urged that the surgeon should remove the opposite tube, but men of ripe experience and judgment are averse to such a proceeding, for it is an established fact that uterine pregnancy is not uncommon after unilateral tubal gestation. ”

“ If there is no tubal and ovarian displacement—that is, if the ovary is not prolapsed; if the uterus has not been retroverted; if there are no extensive tubal adhesions; and if there is no gross disease of the tube, such as pyosalpinx, hydrosalpinx, hematosalpinx, a thorough curetting of the uterus, or, if necessary, a trachelorrhaphy or an amputation of the cervix, will often relieve the woman of her suffering, and it may not be necessary to operate for the damaged tubes. ”

“ My brother, in his dissections, even thought that the uterine extremity of the tube was less changed in point of vascularity, than any other part of it.
When the fœtus does descend into the uterus, it is contained in a double membrane. The internal one is the amnion, and possesses no distinct vessels. The external one is the chorion, and is from the first vascular, and soon becomes so much so, that its vessels have by some been described as forming a distinct tunic. ”

“ On the seventh of August, 1827, he read a paper on extrauterine pregnancy, in which he seemed anxious to establish the opinion, from the historical detail of cases, that ventral or abdominal pregnancy never originally occurred; that tubal or uterine pregnancy had previously existed in cases where the child was found in the cavity of the abdomen, the tube or uterus having been ruptured or ulcerated so as to allow the escape of the fetus from its original location into the peritoneal cavity. ”

“ There is no attempt by the mother in extrauterine pregnancy at expulsion either before rupture or at any other time unless the dead foetus putrefies, and the maternal tissues "try to expel" it as a foreign body by breaking down into an abscess. The foetus simply grows, and its bulk bursts the tube. If it were in the uterus, the uterus would enlarge synchronously with the foetus and there would be no rupture, but the tube will not give beyond a certain point, therefore it bursts. ”

“ After the abdomen has been opened the operation consists in freeing adhesions, rendering patulous the abdominal ostium of the tube, replacing the uterus, and, if necessary, removing the tube and ovary on one or on both sides.
Removal of the tubes and ovaries—salpingo-oöphorectomy—is usually necessary. In pyosalpinx this operation should always be performed. If the woman is young and is very anxious to have children, every attempt should be made to save, at any rate, one tube and ovary. ”

“ Before Primary Rupture.—If the physician is so fortunate as to recognize a tubal pregnancy before primary rupture, he should without delay remove the affected tube and the contained ovum. The operation is simple, is attended by no more danger than that accompanying an ordinary salpingo-oöphorectomy, and the woman is saved the imminent dangers associated with a developing tubal pregnancy. There are no circumstances under which it is proper to follow an expectant treatment. ”

“ To sum up the normal pregnancy, we find that in the course of ten lunar months, following the fertilization of an ovum, the uterus grows from a small, flattened, pelvic organ, three inches in length, to a large, globular, muscular sac, constituting an abdominal tumor about fifteen inches long; it increases its weight thirty-two times, that is from two ounces to two pounds, while the capacity of the uterine cavity is multiplied five hundred times. Within the cavity is a child weighing about seven and a quarter pounds, surrounded by a quart or so of amniotic fluid. ”

“ In a case of prolapse of the ovary, or a gravid tube or ovary in the earliest stages, the operation presents no difficulty and can be carried out with the ease and safety of the simplest ovariotomy; but there are many cases where the tubes and ovaries contain pus and are distended into cysts as big as a fist, or even as large as the patient’s head, which are adherent to bowel, uterus, bladder, indeed everything with which they come in contact; this renders their removal tedious and exacting for the surgeon and dangerous to the patient. ”