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When the vagina is sutured to the sacrospinous ligament, bleeding from the branches of the internal iliac (hypogastric) artery may occur, which can be difficult to stop. Exfoliating tissue anterior to the sciatic spine, you can get into the lateral departments of the cardinal ligament (septum). This formation is abundantly penetrated by the branches of the hypogastric vein. Damage to any of its branches leads to heavy bleeding.



This figure shows the anatomy of the posterior pelvis. At the top are the external and internal iliac veins. The latter goes from above to the sacrospinous ligament, which is stretched between the sciatic spine and the sacrum. On the left is the sigmoid colon. Between the apex of the falling vagina and the sacrospinous ligament, sutures are fixed, fixing and insuring. Sutures on the ligament are applied at a distance of about 4 cm (width of 2 fingers) from the sciatic spine, so as not to damage the shameful artery, vein and nerve. The lumen of the vagina after a hysterectomy is closed. The stumps of anatomical formations that are connected to the uterus are visible. The so-called "septum" (lateral part of the cardinal ligament) is indicated, located between the rectal and peri-bubble spaces. It contains a dense conglomerate of veins, which are branches of the hypogastric vein.

When blunt tissue stratification is performed through an opening in the posterior wall of the vagina, bleeding may occur. Penetration into the peri rectal space is not excluded. This occurs when the surgeon’s finger moves excessively anteriorly, instead of moving posteriorly to the sacrum, trying to palpate the sciatic spine. If the septum is affected by tissue separation, then severe bleeding will begin from the damaged branches of the hypogastric vein and blood will flow out through the vagina.
As a rule, in this situation it is impossible to isolate, take on clips and ligate individual bleeding venous branches.

To stop bleeding, immediately close the rectal space opposite the bleeding vessels should be plugged. After stopping the bleeding, these swabs should be carefully shifted down and to the side. With the help of a long thoracic clamp, it is possible to try to grasp the damaged branches of the venous plexus individually, although this is difficult to do. Therefore, it is better to ligate the bleeding plexus by flashing individual sections of it with a thin synthetic absorbable thread. After each damaged plexus section is stitched, tampons can be moved even further down and to the side and repeat the flashing-ligation of the newly opened section of the septum. These manipulations are associated with a certain risk in relation to the ureter. Therefore, the patient is injected intravenously with the contents of 1 ampoule of indigo carmine and cystoscopically control the appearance of ureter from the ureter on the side of damage to colored urine. If after 10 minutes this does not occur, this ureter should be catheterized. In the case when the bleeding is stopped, but the ureter is bandaged, the surgeon has two options: 1) to open the stitches one by one until one of them releases the ureter and the catheter goes further up; 2) open the abdominal cavity, trace the course of the ureter from above and remove the interfering suture. Damaged veins re-ligated under the control of vision after opening the rectal and peri-bubble spaces.
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    Suspension of the prolapsed vagina using the sacrospinous ligaments is an ideal operation for women who have an active sex life and at the same time suffer from complete prolapse of the vagina. Vaginal prolapse can occur after removal of the uterus, but it can also occur with the uterus preserved. If it is present, it is best to remove the uterus through the vagina, as shown in section 5, page 232.
    Tamponing has again become widely used in trauma surgery and in operations on the pelvic organs. This has an objective justification. Each operating team must adhere to its specific rules regarding the use of tamponade. The basic position is as follows: if the bleeding cannot be stopped by the methods specified in this section of the Atlas and the patient is already
  3. Surgery for abnormalities of the vagina
    Surgical treatment of the longitudinal partitions of the vagina consists in their dissection (Fig. 73), which is performed as planned or during childbirth. The need for such an operation occurs when the septum prevents normal sexual life or the passage of the fetus through the vagina. The septum can be straight through the entire vagina (in such cases, they usually do not violate the function of the vagina)
  4. Surgery for aplasia of the vagina
    Surgery to create an artificial vagina (colpopoiesis) is performed mainly with its congenital aplasia. This is observed in women with developed secondary sexual characteristics and a karyotype of XX, in whom the ovaries are well developed and the hypoplastic uterus with the cervix or its rudiment (Rokytansky-Küster syndrome) is often observed, as well as with the XY karyotype, in which the uterus and ovaries are absent, and in
    Stenosis of the external opening of the vagina is sometimes found in virgins, but more often it occurs in women after the recovery of episiotomy or other reconstructive operations on the perineum. When correcting this pathology, usually accompanied by extreme dyspareunia, the surgeon opens the entrance to the vagina along its posterior edge and reduces the mobilized vaginal mucosa to the posterior commissure and
  6. Tight vaginal tamponade with rupture of the cervix
    Causes of bleeding: cancer decay, trauma, rupture of the cervix. Algorithm Empty the patient's bladder. Moisten a sterile bandage in a solution of hydrogen peroxide, furatsilina or aminocaproic acid. Insert the rear mirror into the vagina. Tightly attach hemostatic gauze to the cervix. On the mirror with tweezers to advance the bandage to the cervix. Introducing a bandage, tightly pad
    This surgery is performed to correct vaginal prolapse. This is a good treatment for women who have an active sex life. Vaginal prolapse can occur after removal of the uterus or when the uterus is preserved. If the uterus is not removed and the woman is in menopause, it is better to remove the uterus before colpopexy is performed (unless there are special reasons to leave it). Sacral
  8. Discirculation and hemostatic disorders in perinatal encephalopathy in premature infants
    The role of violations of the coagulating properties of blood in circulatory-cerebral hypoxia deserves special attention. Increased blood coagulation activity itself is a factor that causes brain hypoxia (V.I. Salalikin, A.I. Arutyunov, 1978). The literature widely presents data on the occurrence of neonatal hemostasis disorders in the form of DIC in connection with severe asphyxia. By
  9. Features of hemostasis during gynecological operations
    The blood supply to the female genital organs changes taking into account the features of their functional state both in the phases of the menstrual cycle and during pregnancy. This is due to differences in the indicators of the blood coagulation system, the volume of the vascular bed in the genitals, and general hemodynamic parameters. In the second phase of the menstrual cycle, there is a decrease in fibrinolytic activity and
    Marshall-Marchetti-Krantz (MMK) and Burch operations are used in cases of severe urinary incontinence. Their meaning lies in the fact that during the operation of the posterior stitching (or suspension) of the urethra, the role of the vesicourethral angle as an intraperitoneal organ is restored. Thereby, the points of application of intra-abdominal pressure change, especially with a sharp increase in moments of coughing, sneezing and
  11. Anesthesia for episodic and perineotomy suturing of ruptures of the perineum, vagina, cervix
    Episio- and perineotomy should be performed under local infiltration or pudental anesthesia. Operations associated with restoring the integrity of the vagina and perineum can be performed using local or pudendal anesthesia with novocaine (0.5% solution), lidocaine (10% solution) or chlorprocaine (1.0% solution). For pudental anesthesia, these solutions in
  12. Suspension of the uterus by the round ligaments
    Uterus ventrosuspension (ligamentoventrosuspensio uteri) is part of the complex of operations used for prolapse and prolapse of the genital organs. It is also used to correct uterine motility or fixed retrograde There are a number of methods for uterine ventilation: Dzhilliam — Kiparsky, Dartig — Webster, Doleri — Dzhilliam, Menges, Menges — Kozinsky, and others (Fig. 77). {foto120} Figure 77.
  13. Uterus fixation
    If plastic surgery of the walls of the vagina is performed regarding their prolapse or prolapse along with the uterus, then in most cases, for the effectiveness of the surgical intervention, its next stage is the fixation of the uterus. The front and back plastic of the walls of the vagina without lifting up and fixing the lowered or prolapsed uterus, according to our observations, are ineffective: relapses occur.
  14. Ligaments (gap)
    Ligaments, or ligaments, connect the bones of the skeleton or individual organs. Located primarily in the area of ​​the joints, strengthen them, limit or direct movements. Ligaments consist of very flexible and durable fabric, but under excessive loads they still break. See also the DISPOSAL article. The purpose of the part of the body in which the ligament rupture occurred indicates what sphere of life this belongs to.
  15. Ligaments and Tendons
    There is a certain confusion in the concepts of ligament and tendon, and there are people who do not see any difference between them at all. The joint ligaments of the two bones provide strength during movement, but the movement itself does not produce. On the other hand, tendons bind the muscles of the bone (almost every muscle ends in a tendon attachment) and at the same time is involved in the process of initiating movement.
    The figures show the distal parts of the skeletons of the limbs and the arrangement of their ligaments. The joints in this section are simple hinges moving in a single longitudinal plane, therefore, having characteristic collateral ligaments restricting the movement of this plane. In addition to the usual collateral ligaments, there are ligaments associated with the sesame-shaped bones on the put and
  17. Lumbosacral radiculitis
    Among the causative factors of the occurrence of lumbosacral radiculitis in children, angina, rheumatism, influenza and other viral infections can be noted. Also toxicoinfectious foci of a chronic nature are important: processes in the ear (otitis media), oral sepsis, and gastrointestinal diseases. In the etiology of lumbosacral pain, a significant role is played by various changes in the spine:
  18. Colposcopic diagnosis of benign changes in various functional conditions of the cervix, vagina and vulva
    Colposcopic diagnosis of benign changes in various functional conditions of the cervix, vagina and
  19. Pain in the lumbosacral spine
    Lumbosacral radiculitis. Clinic. The disease is characterized by lower back pain, aggravated by movement, coughing, sneezing, straining and tilting the head. Sometimes pain radiates to the buttock or leg. At rest, they decrease and even subside. The mobility of the lumbar spine is limited more towards the affected roots. The pose in bed is often forced: the patient lies on
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