. Medical and surgical therapy . r to remove a torn gall-bladder than tosuture it ; or the opening may be tightly enclosed bya large drain opening to the exterior. (d) The Stomach.—-The wounds on the anterior surfaceare easily discovered, the edges trimmed and sutured. We should always carefully attend to hsemostasis ofthe peri-arterial circle. Two of the gastric zonesrequire special means of access, first of all for the inspec-tion and then for the repair of the injuries. These arethe higher part under the diaphragm, and the posteriorsurface. 506 WOUNDS OF THE ABDOMEN The treatise by Forgue a
. Medical and surgical therapy . r to remove a torn gall-bladder than tosuture it ; or the opening may be tightly enclosed bya large drain opening to the exterior. (d) The Stomach.—-The wounds on the anterior surfaceare easily discovered, the edges trimmed and sutured. We should always carefully attend to hsemostasis ofthe peri-arterial circle. Two of the gastric zonesrequire special means of access, first of all for the inspec-tion and then for the repair of the injuries. These arethe higher part under the diaphragm, and the posteriorsurface. 506 WOUNDS OF THE ABDOMEN The treatise by Forgue and Jeanbrau * is the bestto study on this question. The upper part of the stomach is most easily reachedby a similar incision and a similar method on the leftto those which have been described for the liver on theright. Baudet recommends the following procedure :division of the seventh costal cartilage near the sternum,section of the eighth and seventh ribs in the nippleline ; one thus obtains a kind of movable flap, which can. Fig. 57.—Section, vertical and sagittal, to show the routes to thelesser sac of the peritoneam and the posterior surface of the stomach :(I. 1) Trans-mesocolic route ; (2) inter-gastrocolic route ; (3) Inter-colo-omontal route. (II) Anatomical arrangement of the parts whichr nders impracticable ihf in<^er-oolo-ompntal route by reason ofthe extensive and fenestrated adhesions of the omentum and themesocolon (.4). be lifted up to allow a view of the spleen, the left lobe ofthe liver, and the upper part of the stomach (Fig. 63).f * Forgue and Jeanbrau, Gunshot Wounds of the Stomach Rev. de Chir. Sept. Oct. Nov. 1903. t In spite of the fact that fcOxt-book descriptions represent thepleural cavity as being slightly higher on the left side, neverthelessthe greatest care must be taken in dividing the cartilages and inuncovering the flaps from behind, for one may find abnormalities;in the patient whose case we have represented on Plate IV the pleurais wit
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
