[Changes in ligated blood-vessel stumps during abdominal hysterectomy including the removal of the adnexa uteri].

Histological changes of ligated blood vessels were studied on 30 women of 41 to 57 years who had been selected according to certain criteria. For this purpose we usually resected the ligg. suspensoria ovarii, parts of the mesosalpinx, lig. latum and rotundum, the vasa uterina, segments of the basale parametrium the plexus vesico-vaginalis and others after 15 to 25 minutes. The abdominal hysterectomy was in most cases indicated due to uterus myomatosus. The histological examinations showed that, in spite of the ligation of the vessels the organism protects itself by forming a closing thrombus preventing a hemorrhage threatening life as well as a secondary hemorrhage at a later stage due to demarcation of the distal stump end. The occlusion consist of merged thrombocytes, coagulated fibrin and other blood elements; the lesion of the endothelial cells isvery important. Proximal, to the centre, the intravasal mutations decrease rapidly, the lumen is in most of the cases empty. Only in 16% of the lumina of arteries or arterioles and in 20% of the veins there were no hemostatic plugs found. The problem of hemostasis during the gynecological operation is only being touched upon, possible complications due to circulation and perfusion lesions are mentioned. A pathological extent of the coagulation in small pelvis is likely to be the reason for an embolism.