. Manual of operative surgery. portion of the bowel on the left-hand side is that from which the colostomy is eventually incision in the peritoneum, carried forward on the left side, exposes the left ureter as it crosses theleft common iliac vessels. The ureter is drawn aside while the ligature is placed around the inferior mesen-teric vessels. (Illustration taken from Mr. Ernest Miles paper in the British Journal of Surgery, October,1914.) segment of colon forwards and open the connective-tissue space in front of theconcavity of the sacrum. By finger and gauze dissection, fro
. Manual of operative surgery. portion of the bowel on the left-hand side is that from which the colostomy is eventually incision in the peritoneum, carried forward on the left side, exposes the left ureter as it crosses theleft common iliac vessels. The ureter is drawn aside while the ligature is placed around the inferior mesen-teric vessels. (Illustration taken from Mr. Ernest Miles paper in the British Journal of Surgery, October,1914.) segment of colon forwards and open the connective-tissue space in front of theconcavity of the sacrum. By finger and gauze dissection, from above down-wards, detach the rectum (ensheathed in the fascia propria recti) along with its ;io THE RECTUM meson, blood-vessels and lymphatic glands from the ligamentous structuresin front of the sacrum (Fig. 657). Carry this separation down to the level of the sacro-coccygeal articulationwhich may be recognized by the firm attachment of the fascia propria rectito the end of the sacrum. Do not injure the median sacral /;«*: >tti. Fig. 657.—Showing the rectum and the retrorectal tissues separate from the hollow of thesacrum as far as the sacrococcygeal articulation. After ligature of the inferior mesenteric vessels, the remains of the pelvic mesocolon are divided belowthe ligature, and the incisions in the pelvic peritoneum are carried forwards on either side along the lateralwall of the pelvis. The cellular space in front of the sacrum is opened up as far as the coccyx. (Illustrationtaken from Mr. Ernest Miles paper in the British Journal of Surgery, October, 1914.) Step 5.—Bring the two peritoneal incisions forward around the rectum tomeet behind the base of the bladder in the male or the upper portion of thevagina in the female. Look out for the ureters which are adherent to theparietal peritoneum as they skirt the lateral wall of the pelvis on their way tothe bladder. Bluntly separate the anterior wall of the rectum from the bladder and seminalvesicle
Size: 1666px × 1500px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
