368 The Pelvis 



Unless the bleeding be furious and fatal, it trickles into \x> 

 pouHi (p. 390), where peritonitis adhecioiu may enclose it, CO 

 small intestine forming the roof of the cyst-wall. When the effusion 

 a peritoneal i' l:l:Hy be t v, eej, the layr-rs of the broad 



ligament, and is due to the rupture of a varicose ovaria 



, be diffused within the pelvis, in which case it may float the 

 Uterus out of the reach of the finger. In the ( ase of sub-pen 1 



, vacation, the ha-matoccle is Hi 'ed. 



When the bleeding is into the peritoneal cavity there is sudden 

 and great shock; the pressure upon the front of the return causes 

 constant desire to defalcate, and the patient lies on her ba< k with the 

 knees drawn up. Suppuration may occur, the tumour discharging 

 itself by the rectum or vagina, or into the general peritoneal cavity. 

 The cavity may be evacuated by puncture through the vagina or 

 rectum, as the bulging may indicate. 



THE COMMON ILIAC ARTERIES 



The common iliac arteries come from the bifurcation of the aorta at 

 the left side of the fourth lumbar vertebra ; and as they divide opposite 

 the alae of the sacrum the right has to run the longer com 

 surface-marking see p. 164.) The artery begins about half an inHi 

 below and to the left of the umbilicus in the line connecting the 

 highest points of the iliac crests. Each is about 2 in. long, and the 

 longer they arc the shorter are their terminal trm. 



Relations. The right Briery rests upon both common iliac- 

 upon their confluence to form the vena cava, and upon the fifth lumbar 

 \eitebra; the left similarly rests upon that vertebra, and upon the 

 left common iliac vein. (See fig. on p. 353.) 



In front of each common trunk are the peritoneum and coil-, of 

 intestine, and close to the bifurcation is the ureter. Additional ani 

 i Hat ions on the left side are the beginning of the rectum, and the end- 

 ing of the inferior mesenteric artery in the superior ha-morrhoi<: 



ween the common iliac arteries are the rectum and the left 

 common iliac vein. External to each trunk is the psoas, and, in 

 addition, on the right side are the ending of the right vein and the 

 lining of the cava. 



Rule. --.piHmv the diaphragm the veins of the trunk are on a | 

 posterior to the arteries (except the renal), and inclining generally to 

 the venous, the i i;;ht, side. 



Irreffularl tie*. Tin- < ommon iliar artery may fall short of, or 

 exceed the average length of two inches. Sometimes the trunl. 

 off the middle sa< ral or the il'io lumbar artery. 



Xiiration of the common lilac artery. A curved iu< ision of 4$ 

 or 5 in. i . mad- ihiou ;; h the l.in and ',upcr!i< ial fasciae from the outer 



