. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 249.—Appendectomy. The appendix buried. The peritoneum over theappendix is split longitudinally. appendix split longitudinally, and the muscular coat separatedfrom the peritoneal by blunt dissection around its entire circum-ference. Slight traction on the exposed portion, while bluntdissection continues toward its tip, brings out the entire ap-pendix minus its peritoneal coat. In this event no mesenteric APPEXDECTOMY 547 ligature is needed, a stitch or two in the separated peritonealshell controlHng the bleeding.
. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 249.—Appendectomy. The appendix buried. The peritoneum over theappendix is split longitudinally. appendix split longitudinally, and the muscular coat separatedfrom the peritoneal by blunt dissection around its entire circum-ference. Slight traction on the exposed portion, while bluntdissection continues toward its tip, brings out the entire ap-pendix minus its peritoneal coat. In this event no mesenteric APPEXDECTOMY 547 ligature is needed, a stitch or two in the separated peritonealshell controlHng the bleeding. In cases of acute appendicitis which have lasted sufficientlylong to provoke many adhesions, or in which perforation andabscess have developed, the preliminary walling off of the. Fig. 250.—Appendectomy. The appendix buried. The muscular coat isseparated from the peritoneal by blunt dissection. abdominal cavity should be very carefully performed beforeinterfering with the caecum or the mass of adhesions in which theappendix is buried. Sometimes one wall find the anteriorabdominal wall adherent to the mass beneath the incision, inwhich event packing can be dispensed with, but any opening inthe wall of adhesions should be carefully plugged, both to pre- 54^ DISEASES ASSOCIATED WITH GYNJECOLOGIC LESIONS vent leakage of pus into the healthy peritoneal cavity and pro-trusion of healthy gut into the infected region. If there are nosuch adhesions the abdominal cavity should be protected, below,toward the median line, and above, by a sufficient number ofsponges to prevent contamination. It is true that intra-abdom-inal pressure will usually cause all pus to flow outward, but the
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