. American practice of surgery ; a complete system of the science and art of surgery . lass, has a diameter somewhat lessthan that of the colon, is six or eight inches in length, and is proAided with a double flange atthe end which enters the bowel; the object of the flange being to secure the tube in place. 942 AMERICAN PRACTICE OF SURGERY. down to the mesentery, and the protruding edges may then be cut away, leavinga distinct sulcus between the upper and lower apertures. (Fig. 391.) Theopening of the intestine does not require the employment of an aUcTsthetic, asit produces no pain unless th
. American practice of surgery ; a complete system of the science and art of surgery . lass, has a diameter somewhat lessthan that of the colon, is six or eight inches in length, and is proAided with a double flange atthe end which enters the bowel; the object of the flange being to secure the tube in place. 942 AMERICAN PRACTICE OF SURGERY. down to the mesentery, and the protruding edges may then be cut away, leavinga distinct sulcus between the upper and lower apertures. (Fig. 391.) Theopening of the intestine does not require the employment of an aUcTsthetic, asit produces no pain unless the mesentery is cut. In the latter case a lightgeneral or a local ansesthetic will have to be employed. Closure of a Temporary Artificial Anus.—The method of closing an artificialanus will depend altogether upon the way in which it has been made and uponthe amount of the bowel which has been sacrificed in making the opening. Ifthe method of Allingham or of Bodine (Fig. 393), for making the spur and cut-ting away the loop of the bowel has been employed, then the spur may be divided. Fig. 391.—Drawing Illustrates a Case in which the Bowel is Cut through for the Purpose ofEstabhshing a Permanent Artificial Anus. (Tuttle.) by long pressure-forceps, and the edges of the bowel around the abdominalopening may be dissected loose and then united by Czerny-Lembert sutures;the skin and muscle layers being brought together above. The objection to thisplan is that it leaves the bowel in a very distorted condition. An end-to-endanastomosis would, under these conditions, be decidedly preferable. AVhen the bowel has been opened first by a longitudinal incision extendingdown to a point half an inch below the glass rod, and then by a transverseincision bisecting the lower end of the first, Tuttles method for closing theartificial anus (mentioned above) may be used with advantage. The T-shapedwound in the bowel is then brought together first by silk sutures passed throughthe mucous membrane, a
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
