. Manual of operative surgery. Fig. 544.—{Pauchei & Dunn.) GASTRECTOMY 407 proceed as follows: Working from below upwards by sharp dissection, separatethe cancerous pylorus from the ])ancreas and mesocolon (Fig. 544). Theremay or may not be oozing of blood during this step but there will not be realhemorrhage. Slcp 3.—Mobilize the duodenum down to the pancreas. Ligate the vesselsfollowing the u])])er and lower borders of the duodenum. Crush, divide andclose the duodenum as described on ]). 398. As a precaution cover the duodenalstump with a cap made from remnants of the gastro-hepatic omentum
. Manual of operative surgery. Fig. 544.—{Pauchei & Dunn.) GASTRECTOMY 407 proceed as follows: Working from below upwards by sharp dissection, separatethe cancerous pylorus from the ])ancreas and mesocolon (Fig. 544). Theremay or may not be oozing of blood during this step but there will not be realhemorrhage. Slcp 3.—Mobilize the duodenum down to the pancreas. Ligate the vesselsfollowing the u])])er and lower borders of the duodenum. Crush, divide andclose the duodenum as described on ]). 398. As a precaution cover the duodenalstump with a cap made from remnants of the gastro-hepatic omentum or ofgreat omentum. This may be done at a later stage of the operation but shouldnot be omitted. Step 4.—^Complete the operation as described on p. Fig. 545.—{Pauchel er Dunn.) —^The special rules for the after-treatment of stomach opera-tions are, shortly, as follows: (a) If the patient is much dehydrated, give intravenous or subcutaneousinfusions of saline solutions. These may be repeated during a few days ifnecessary. If not dehydrated and if stimulation is necessary, administer sub-cutaneously a 20 per cent, solution of camphor in sterile olive oil. As thepatient leaves the operating-table 8 ounces of warm coffee should be givenper rectum. Murphys proctoclysis is excellent. Transfusion of blood isoften of life-saving value. Morphine in an efficient dose may be administeredif required. {b) As soon as the effects of the anesthetic wear off (within hours)raise the patient into a sitting or rather semi-sitting posture. This tends toobviate pulmonary disturbances and is important. 408 THE STOMACH (c) Small doses of hot water or tea may be given as soon as nausea is over-come. Water, if well born by the s
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