. A manual of operative surgery . varian pedicle. It is easily recognised, onaccount of the pampiniform plexus of veins, which is conspicuouseven in the normal condition. In ovarian cystic disease thisligament becomes hypertrophied, and appears as a conspicuousfold running from the brim of the pelvis on to the pedicle. The layers of the broad ligament are closely applied betweenthe tube and the ovary. Below the level of the ovary the layersseparate, and pass to the sides of the pelvis. The pelvic connec-tive tissue fills the space formed by the parting of the layers.This tissue can be felt as
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. A manual of operative surgery . varian pedicle. It is easily recognised, onaccount of the pampiniform plexus of veins, which is conspicuouseven in the normal condition. In ovarian cystic disease thisligament becomes hypertrophied, and appears as a conspicuousfold running from the brim of the pelvis on to the pedicle. The layers of the broad ligament are closely applied betweenthe tube and the ovary. Below the level of the ovary the layersseparate, and pass to the sides of the pelvis. The pelvic connec-tive tissue fills the space formed by the parting of the layers.This tissue can be felt as a tense band, running from the uterusto the side of the pelvis, on digital exploration of the vagina. 430 ABDOMINAL OPERATIONS [PART II When the rectum is explored, the back of the broad ligamentcan be reached. This is impossible in vaginal examination. The layers of the broad ligament are often separated bytumours, which push in between them, either from the directionof the ovary or from the uterus, as in fibroid tumours. In the. FIG. 117.—THE ARTERIES OF THE INTERNAL FEMALE ORGANS. [Modifiedfrom Hyrtl. a, Ovarian artery ; b, Uterine artery ; c, Anastomosis of ovarian and uterine arteries ; d, Arteryto the cervix ; e, Vaginal arteries ; / Azygos artery of vagina ; A A, Line of amputationin supravaginal hysterectomy ; B B and D D, Vessels secured in hysterectomy ; B B andd d, Vessels secured in ovariotomy ; c C, Vessels divided in freeing the cervix. former case there will be difficulty in making a good pedicle ;in the latter oophorectomy may be dangerous, as the broadligament no longer forms a sheet-like structure, but often becomesa pyramidal body, with its base towards the uterus, highlyunsuited for the safe application of the ligature. The ovarian artery (Fig. 117) enters the broad ligament fromthe pelvic brim, and becomes very tortuous when it reaches theinfundibulo-pelvic ligament ; and this tortuousness increases as CHAP. XV] OVARIOTOMY 43i it passes between the layers