=Injury to a gravid uterus in the course of an abdominal operation.= In spite of every care it has happened on many occasions that a pregnant uterus has been mistaken for an ovarian cyst, the abdomen has been opened and a trocar plunged into the uterus. In some instances a uterus in which the pregnancy has advanced as far as the sixth month has been removed under the impression that it was a large ovarian cyst, and this accident has happened with a pregnant uterus greatly enlarged in the somewhat rare condition known as hydramnios. A pregnant uterus is also liable to be stabbed by an ovariotomy trocar when the condition is complicated with unilateral or bilateral ovarian cysts. The gravid uterus has very thin walls and, occasionally, resembles so very closely an ovarian cyst as to deceive an inexperienced operator. When the surgeon finds that he has injured a pregnant uterus in the course of an abdominal operation three courses are open to him, each of which has been practised with success by surgeons of renown:-- 1. Sew up the incision in the uterus. 2. Perform Cæsarean section. 3. Remove the uterus (subtotal hysterectomy). Several cases have been reported in which injury to a gravid uterus during ovariotomy has terminated fatally, especially when the surgeon followed the plan of sewing up the wound in the uterus. A careful consideration of the reported cases indicates that the best results follow for the patient when the surgeon performs Cæsarean section, as the following record shows:-- Sir Spencer Wells had removed a large, multilocular ovarian cyst from the left side of the patient, when he felt what was supposed to be a cyst of the right ovary. When tapped it was found to be a gravid uterus, in which pregnancy had advanced to near the fifth month. Cæsarean section was at once performed and the patient recovered. Injuries of this kind are rarely likely to happen now, for the clumsy ovariotomy trocar is passing out of use. [Illustration: FIG. 24. DIAGRAM REPRESENTING A GUNSHOT INJURY OF THE UTERUS. The woman was aged 28, and in the seventh month of pregnancy. The bullet was extracted from under the skin on the left side, four inches behind the anterior superior spine of the ilium. The line A B represents the track of the bullet. (_British Medical Journal_, 1896, vol. i, p. 332.)] =Bullet-wounds of the pregnant uterus.= These are very rare, and, like rupture of the uterus, liable to be complicated with injury of the intestines; it is for this reason that the canon of surgery applicable to penetrating wounds of the abdomen should be practised in these circumstances, and the patient submitted to cœliotomy.