INTRA-PELVIC TECHNIC (Manipulative
Surgery of the Pelvic Organs)
PERCY H. WOODHALL, M.D., D.O.
Indications and Contraindications
Intra-pelvic technic is particularly valuable in the treatment of displacements,
lessened mobility of the uterus, subinvolution, metritis, ovaritis, salpingitis,
passive pelvic congestion and many cases of inflamed or obstructed ureters,
and in fact any case of subacute or chronic inflammation within the pelvis
not accompanied by malignant or tubercular involvement or pus accumulation.
In pregnancy to relieve pressure symptoms or to give relief from obstinate
vomiting good results are often obtained.
It is contraindicated by malignancy, tubercular inflammation, particularly
if purulent, the presence of confined pus, and ectopic pregnancy.
It is easily apparent that no manipulation should be attempted in malignant
diseases of any of the pelvic organs. No possible benefit would accrue
and harm would undoubtedly result. Inflammation and metastases elsewhere
would naturally be expected. The same is true to a lesser extent of tuberculosis
of the pelvic viscera.
In most cases of acute inflammation the pain caused by the manipulation
of the affected part would prevent the treatment being used. In acute inflammatory
conditions intra-pelvic technic should not be attempted until several weeks
have elapsed since the subsidence of all acute symptoms, and even then
it sometimes happens that treatment is followed by a slight return of the
acute symptoms. These must be allowed to subside before the treatment is
Confined pus, if the microorganisms are still active, and this is a
difficult matter to determine, is a contraindication. Old collections of
pus are said to become sterile, but even so, it is not wise to risk the
rupture of a pyo-salpinx or the expression of pus through the fimbriated
extremity of the uterine tube. So if pus be suspected in a tube the treatment
should be given with extreme care. All manipulations should be made toward
the uterus so as to drain the tube in that direction and reactions after
treatment as to pain and. temperature should be carefully watched. In cases
of a well-developed pelvic abscess surgical drainage is the indicated treatment.
In an ectopic pregnancy any manipulation might cause serious hemorrhage
until after the death of the foetus and the organization and encapsulation
of the extravasated blood and damaged tissues. After this has occurred
the disappearance of the mass is often facilitated by intra-pelvic technic
carefully and properly applied.
Menstruation is not a contraindication but an indication for great care
and gentleness. Ordinarily the intra-pelvic technic is suspended during
the periods, but in some cases of dysmenorrhoea, and in stubborn cases
of displacements caused by adhesions, more can be accomplished at this
time than at any other, the adhesions seemingly being less resistant than
Fever, unless clearly due to acute inflammation about the pelvis, is
not a contra-indication but is also an indication for extreme care and
gentleness and a close scrutiny of reactions after each treatment. If the
treatment is followed by a slight rise of temperature or a marked increase
of discomfort these must be allowed to subside for several days before
the treatment is repeated.
Fig. 1. The Uterus in Normal
(Findley, Diseases of Women.)