Weibel states that a ureteral fistula due to necrosis after a radical
operation for cancer of the uterus usually occurs in the second week.
The earliest day is the seventh, and the latest the eighteenth day after
operation. The majority of these fistulæ heal in from three to twelve
weeks. If a fistula persist for more than three months spontaneous
healing is not to be expected. A ureteral fistula is a serious matter
for the patient. Blacker has had three cases after total hysterectomy.
In one the kidney was removed on account of septic changes. The second
had an attack of suppression of urine lasting twenty-four hours; it
passed off, the patient recovered and the fistula healed. The third died
eight weeks after the hysterectomy with symptoms of pyæmia; a small
abscess had formed near the site of the fistula.
=The fate of ligatures.= When a ligature is satisfactorily applied to a
pedicle the tissue on the distal side of the ligature is isolated from
the circulation. The fate of this tissue and of the ligature has been
the subject of much speculation.
It is a matter of common observation that when animal tissues are cut
off from the circulation, they atrophy; but if pathogenic
micro-organisms gain access to such parts, suppuration ensues. In due
course, through the activity of the living cells, the dead tissues are
detached from the living, a process termed sloughing.
When a piece of healthy tissue is removed from the body and immersed in
a sterile solution, and absolutely isolated from the atmosphere,
decomposition is indefinitely postponed, but as soon as unsterilized air
is allowed access to it, putrefactive changes ensue. The pedicle after
ovariotomy is in an air-tight chamber, and if the tissues included by
the ligature are healthy, and the silk employed for the purpose is
absolutely aseptic, this pedicle, when returned into the abdomen,
resembles the piece of tissue isolated from contact with the atmosphere.
No septic changes occur, but aggressive leucocytes attack the silk and
may, in course of time, effect its removal, even the knots. For this
desirable result three conditions require to be fulfilled: (1) the
ligatured tissue must be aseptic; (2) the ligature should be absolutely
sterile; and (3) air or intestinal contents must be excluded.
These conditions may be prevented in many ways. The tissues included in
the ligature are not always free from infective organisms, especially
the Fallopian tube, which is usually included in the ligature, and this
structure, especially in cases where oöphorectomy is performed for
inflammatory diseases, often contains septic microbes; this endangers
the ligature and leads to the formation of pus, with its complications,
sloughing of the pedicle and abscess. The tissues may be healthy and
aseptic, but the ligature may have been imperfectly sterilized, or
become contaminated by assistants, or even by the hands of the surgeon
during its application.
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