[Reprinted from the American Gynaecological and Obstetrical Journal 
for March, 1895.] 
A CASE OF VENTRO-FIXATION OF THE UTERUS 
FOLLOWED BY PREGNANCY, ILLUSTRATING 
THE VALUE OF CONSERVATIVE OVA- 
RIAN SURGERY* 
Instructor in Gynaecology, PlaiTadelphia Polyclinic. 
Frank W. TaLley, M. D., 
I venture to report the following case of ventro-fixation, as it beau- 
fully illustrates the value of leaving ovarian tissue if possible : 
Mary A., aged twenty-five years ; dressmaker ; primipara ; puberty 
at sixteen ; menses always were irregular, at times not occurring for 
several months ; scanty ; flow lasts four or five days ; suffers severely 
from dysmenorrhoea. 
Four years ago she gave birth to a child at full term. The labor 
was comparatively easy. On the ninth day after her labor she got up, 
and going out, the day being damp, contracted a cold. She was then 
sick for six months with chills, fever, and great tenderness and pain in 
the abdomen. Five months after her labor she says an abscess pointed 
in her right side and was opened. The opening discharged for more 
than a year and then closed. A scar remains in the right iliac region 
near the inner margin of the right anterior inferior spine of the ilium. 
She complains now of leucorrhoea and constant pain in the small 
of the back and sides, from which she has suffered since the birth of 
her child. 
Examination : Perinaeum good; uterus large, retroflexed and 
drawn to the right side, firmly fixed in its false position ; left ovary 
large, tender, prolapsed and also fixed. 
On the 24th of April, 1894, she entered the Polyclinic Hospital, 
and two days later the abdomen was opened by a median incision. 
The fundus of the uterus was freed from its adhesions posteriorly. 
The right broad ligament was represented by a thick indurated band 
of fibrous connective tissue in which no evidence of tube or ovary 
* Read before the Philadelphia Obstetrical Society, February 7, 1895. 
Copyright, 1895, by J. D. Emmet and A. H. Bi ckmaster. 2 
Frank W. Talley, M. D. 
were to be found. Evidently the abscess which had pointed in her 
left side had been a tubo-ovarian abscess, which had burrowed between 
the layers of the broad ligament and through the walls of the abdo- 
men pointing in the right iliac region. During the long suppuration, 
the sinus having discharged for more than a year, the tube and ovary 
had lost their identity in the organized cellular infiltrate about them. 
This fibrous band was divided near the uterus between two liga- 
tures. The left ovary, which was prolapsed and adherent, was then 
freed. The tube was apparently patulous. During the separation of 
the ovary from its adhesions a blood cyst was ruptured and there was 
considerable haemorrhage from the ovarian stroma. To control this a 
portion of the ovary corresponding to the injured part was resected 
and its capsule stitched with fine silk suture. The uterus was then 
brought forward and the fixation made. The fundus was supported 
behind the pubic symphysis by the finger of the assistant. A fine 
silk stitch was then passed in the lower end of the incision through 
the posterior half of the abdominal wall, including a few fibers of the 
rectus muscle, the posterior lamella of the sheath of the rectus, sub- 
peritoneal fat and peritonaeum on the one side, passing through the 
fundus of the uterus, from side to side, just posterior to a line drawn 
between the tubal attachments and through the posterior half of the 
abdominal wall on the other side. A similar stitch was passed half 
an inch higher up in the abdominal wall and half an inch farther 
back in the posterior surface of the uterus. These stitches on being 
tied retained the uterus in anteversion. The remainder of the abdom- 
inal incision was closed in the usual manner. The patient made a 
good recovery and was dismissed from the hospital three weeks after 
her operation. 
December 22d the patient returned, stating that she believed her- 
self to be pregnant. Vaginal examination showed the uterus some- 
what enlarged, softened and anteflexed. The fixation to the ab- 
dominal wall was not rigid, and the uterus was allowed considerable 
latitude of movement. An examination of the breasts confirmed 
the uterine symptoms of pregnancy. 
January 17, 1895, the signs of pregnancy were again corroborated. 
The case is interesting from two points of view : First, as teaching 
the importance of conservatism in dealing with the ovary ; and second 
as a case of ventro-fixation followed by pregnancy a few months after 
the operation.