Chap, xviii.] THE PELVIS. 343 



rectum the fascia Teaches the level of a line drawn 

 from the top of the'^serrdrml vesicles t t o ;fche middle oii the 

 fifth piece of the sacrum. In the middle line it 

 reaches a point scmo little vay be^ow the rsoto 

 vesical cul-de-sac of '"tli:e"pefitonerr]. These excluded 

 portions of the various viscera may be wounded 

 without the pelvic cavity being opened up, and 

 suppuration spreading from them would tend to 

 spread towards the perineum, and not into the pelvis. 

 Pelvic cellulitis, to use the term in the strict sense, 

 means inflammation of the connective tissue between 

 the pelvic fascia and the peritoneum.* This connec- 

 tive tissue is chiefly situated between the anterior 

 wall of the bladder and the pelvis, about the base and 

 neck of the bladder, between the latter viscus and the 

 rectum ; and in the female, between the layers of the 

 broad ligament and about the lower part of the 

 uterus and commencement of the vagina. All this 

 connective tissue is continuous, and inflammation in 

 one part of it may spread to the other parts. In 

 women the mischief is often found between the folds 

 of the broad ligament, or in the hollow between the 

 uterus and the rectum. As may be supposed, the 

 abscess formed in such cases tends to mount up in the 

 pelvis, being unable to escape below, and usually 

 points in the inguinal region. It may, however, open 

 into one of the pelvic viscera or into the peritoneum, 

 but both these terminations are rare. Out of thirty- 

 seven cases of puerperal pelvic cellulitis with suppu- 

 ration, twenty-four burst externally, and for the most 

 part in the inguinal region (McClintock). 



It should be borne in mind that the blood-vessels 

 of the pelvis are placed on the peritoneal aspect of the 

 fascia. The branches of the internal iliac artery, 

 therefore, that leave the pelvis, escape by piercing that 



* Clinically the term pelvic cellulitis includes also pelvic peri- 

 tonitis, and often inflammation of one or other of the viscera. 



