Hydrosalpinx and Dropsy of the Pavilion of the Oviduct 45 1 



gland. In other instances, the margin of the pavilion ad- 

 heres to the ovary while the general mucous surface of the 

 funnel remains free. It then participates in the cystic dis- 

 tension and in some cases becomes enormously enlarged, as 

 shown in Fig. 159. In other types of hydrosalpinx, the tube 

 and pavilion remain perfectly free. The ostium abdominale 

 of the oviduct becomes occluded and the pavilion of the ovi- 

 duct recurved over the ampulla, leaving a knob-like enlarge- 

 ment at the end of the oviduct. It is still adherent by one 

 or two fimbriae to the lateral end of the ovary, but these 

 fimbriae, on account of the weight of the oviduct, may be 

 very greatly elongated so that the cystic oviduct may drop 

 far forward and lie lower down in the abdominal cavity. 

 In order that this may occur, the mesosalpinx must also be- 

 come greatly stretched as a consequence of the weight of 

 the cystic fluid. Amongst these three most distinctive types 

 there is every possible variation. The condition is almost 

 invariably associated with either a cystic degeneration of 

 the corpus luteum or a fibrous degeneration — sclerosis — of 

 the ovary as a whole. Presumably these changes in the 

 ovary are the result of a passage of infection by contact into 

 the ovary, generally through the wound caused by the rup- 

 ture of the ovisac at the time of ovulation prior to the pe- 

 riod of complete closure of the oviduct. 



The diagnosis of hydrosalpinx should be based upon the 

 enlargement of the oviduct as described. Sometimes the 

 cystic condition involves chiefly a small segment of the ovi- 

 duct ; sometimes it involves with great uniformity the en- 

 tire length. The size of the cystic oviduct will vary between 

 a trifling enlargement beyond normal up to three-quarters 

 to seven-eighths of an inch in diameter or possibly larger. 

 The length of the oviduct is also enormously increased — at 

 times 8 to 10 inches long — especially when the entire duct is 

 free. Extensive adhesions tend to restrain the duct from 

 becoming greatly elongated and throw it into very compli- 

 cated convolutions. A cystic condition of the pavilion is to 

 be diagnosed largely by its extreme softness and its posi- 

 tion as related to the ovary. As shown in Fig. 159, the 



