154 TOPOGRAPHIC AND APPLIED ANATOMY. 



The longitudinal diameter, which connects the tubal with the uterine pole of the ovary, is almost 

 vertically placed; the external surface is in immediate contact with the lateral pelvic wall, at 

 the level of the pelvic inlet, close to the inner border of the psoas muscle. The suspensory 

 ligament of the ovary (ligamentum infundibulopelvicum) runs from the lateral pelvic wall to the 

 superior or tubal pole and transmits the ovarian vessels to the ovary (Fig. 72). Posteriorly the 

 ovary is in relation with the ureter and the uterine artery, above and anteriorly it borders upon 

 the remains of the hypo gastric artery (ligamentum umbilicale laterale). The position of the ovary 

 is not absolutely fixed and is often abnormally influenced by inflammatory processes in the 

 neighborhood. The gynecologist should be able to palpate the ovary by bimanual examination 

 through the vagina and the anterior abdominal wall, in which procedure the vaginal finger 

 reaches chiefly the uterine pole and the internal surface of the viscus. 



The Fallopian Tube. The Fallopian tube is situated in the free border of the broad liga- 

 ment and cannot pursue a straight course in the restricted confines of the true pelvis. We 

 differentiate three portions of its course : The first portion or isthmus passes horizontally outward 

 from the uterus to the uterine pole of the ovary; the second portion makes a right angle with 

 the first and runs upward from the anterior margin of the ovary to its superior pole; after making 

 another acute turn, the third or terminal portion runs backward and downward and terminates 

 at the ostium abdominale, which is directed toward the posterior free margin of the ovary. 



The Rectum. In the female the rectum has the same curves as those described in the male. 

 Its anterior wall is in relation with the uterus (the recto-uterine pouch being interposed) and 

 the vagina; the cervix may be palpated through this wall by the finger introduced into the 

 rectum. The rectovaginal septum is composed of loose areolar tissue and is predisposed to the 

 formation of rectovaginal fistulas after marked distention and laceration of the vagina. 



REVIEW QUESTIONS. 



How may the bladder be entered anteriorly without injuring the peritoneum? 



Why are injuries of the anterior wall of the bladder (such as a rupture, for example) less dangerous 

 than those of the posterior wall? 



From what situation may we palpate and operate upon the bladder (in the male), the prostate 

 gland, and the seminal vesicles? 



How does the enlargement of the prostate gland affect the internal orifice of the urethra? 



To what height may we operate upon the anterior rectal wall without endangering the integrity 

 of the peritoneal cavity ? 



To what parts may a carcinoma of the rectum extend anteriorly? 



From what situation may the posterior wall of the bladder be opened in the female? 



Which wall of the cervix may be incised without danger of opening the peritoneal cavity, and in 

 which wall does this danger exist? 



What is the relation of the inferior extremity of the ureter to the vagina ? 



What peculiarity of the female urethra is of importance from a practical standpoint? 



Is it easier to enter the peritoneal cavity through the anterior or through the posterior vaginal 

 vault ? 



What has happened when urine dribbles from the cervix or from the vagina, and what when feces 

 escape through the vagina? 



