Operative surgery . cautions.—The division of the epigastric artery will be an em-barrassing complication. However, as it runs upward and inward frombehind the middle of Pouparts ligament, it can be easily avoided by cuttingoutside of the latter point. Care should be taken to obviate a twist in thepresenting loop of intestine for self-evident reasons. It is likewise apparentthat the opening of a collapsed intestine will afford no relief. Scrupulousattention should be given to the condition of the patient during operation byone assigned for that purpose, otherwise an unexpected sudden demise of
Operative surgery . cautions.—The division of the epigastric artery will be an em-barrassing complication. However, as it runs upward and inward frombehind the middle of Pouparts ligament, it can be easily avoided by cuttingoutside of the latter point. Care should be taken to obviate a twist in thepresenting loop of intestine for self-evident reasons. It is likewise apparentthat the opening of a collapsed intestine will afford no relief. Scrupulousattention should be given to the condition of the patient during operation byone assigned for that purpose, otherwise an unexpected sudden demise of thepatient will deepen the responsibility for the case. If the intestine be muchdistended the walls may be correspondingly thinned, and therefore readilypunctured in sewing, causing infection of the deep tissues of the wound andperhaps of the peritoneal cavity itself. The Remarks.—The opening in the gut should be as small as practicable,to avoid undue prolapse of the mucous lining of the bowel, and to limit the. Fig. 882.—Enterostomy, Kochersmethod, a. Parietal perito-nteum. h. Aponeurosis of ex-ternal oblique ni. c. Transver-salis fascia, d. Intestine. 672 operativp: surgery. area of subsequent repair. The length of the primary incision will be regu-lated principally by the thickness of the abdominal walls. If the element oftime be unimportant, the borders of the divided peritonaeum can be firststitched to those of the integument, thus lining the opening with serousmembrane, thereby providing a firmer and securer union between the intes-tine and the borders of the opening. The Results.—Xot infrequently the establishment of a faecal fistula curesentirely the original infliction, and later the faeces flow uninterruptedlythrough the normal channel. The following statistics compiled by Curtis,bearing on the results of enterostomy in acute intestinal obstruction, empha-size the importance of the procedure in no uncertain terms. In sixty-twocases 46 were relieved, 6 unrelie
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