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At the same time a profuse diarrhoea set in and a purulent vaginal discharge. In four months particles research paper services hair began passed in the vaginal discharge, and a large mass from the rectum.

A few days afterwards the vaginal discharge became fetid and contained feces.

These symptoms lasted intermittently for a number months.

In nine months after delivery the menses recurred at normal intervals. With custom written essay the disappearance professional grad school essay writers can somebody write my essay the inflammatory symptoms the discharge, and the passage hair and faecal matter, ceased. I saw the patient first in June. She was thin and anemic, but able attend her household duties.

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The vagina was distended a tumor the size a fist, and pear-shaped, and resembling a polyp. The surface the tumor was covered in places with hair which could readily removed the finger. The pedicle was as thick as the finger and proceeded from an opening in the left lateral fornix, through which the finger could passed into a cavity resembling that Douglas.

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There was a second opening at the lower border the pedicle, which extended into the rectum. The uterus was elevated and anteposed, not specially movable, and a trifle cheap term papers sale enlarged. There was no palpable exudation in the pelvis, and the ovaries and the tubes could not felt. I reached the diagnosis inverted dermoid cyst prolapsed into the vagina explanation the occurrence was that a dermoid cyst the left ovary? adherent in Douglas's pouch, had proved the obstacle delivery, at which time the fornix vagina was torn transversely, and through this tear a portion the cyst prolapsed and this was the beginning the inversion. The communication with the rectum did not form till later, since faeces did not pass per vaginam till the fourth month after delivery. I removed the cyst vide. and the patient recovered well, but as yet she has refused operation the fistula. The diagnosis recto vaginal fistula easy ordinarily, since can readily examine the recto-vaginal septum.

The finger may usually detect even a small fistula when its borders are thickened. write my paper one day The patency the fistula may determined one finger in the rectum, and another in the vagina. In case very small fistulas the sound assistance. If the matter still in doubt, injection fluid into the rectum will settle Further still, the posterior vaginal wall and the anterior rectal may exposed the speculum. As for differential diagnosis, the only thing which might simulate the symptoms fistula the passage air and fasces into the vagina from without. See under Foreign Bodies in the The treatment a recto-vaginal fistula can only effective when is possible control the ulcerative process, and cause regular cicatricial contraction its borders, and when the size the defect permits of closure. 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