. Manual of operative surgery. gmoid colon maysubsequently give rise to volvulus. In at least one case, even after much ofthe sigmoid was excised for volvulus, the remnant of sigmoid between theanastomosis and the rectum became hugely dilated and once more occasionedvolvulus. Mr. Makins corrected the position of the loop and fixed it withgood effect (Hawkins, Brit. Med. Journ., March 2, 1907). Yeomans (Am. Journ. of Surg., Jan., 1913) recommends caeco-sigmoidos-tomy instead of ileo-sigmoidostomy in suitable cases as by it a more thoroughdrainage of the segregated or excluded colon can be obtai
. Manual of operative surgery. gmoid colon maysubsequently give rise to volvulus. In at least one case, even after much ofthe sigmoid was excised for volvulus, the remnant of sigmoid between theanastomosis and the rectum became hugely dilated and once more occasionedvolvulus. Mr. Makins corrected the position of the loop and fixed it withgood effect (Hawkins, Brit. Med. Journ., March 2, 1907). Yeomans (Am. Journ. of Surg., Jan., 1913) recommends caeco-sigmoidos-tomy instead of ileo-sigmoidostomy in suitable cases as by it a more thoroughdrainage of the segregated or excluded colon can be obtained. C^CO-SIGMOIDOSTOMY 441 Caeco-sigmoidostomy.—Typhlo-sigmoidostomy.—Put the patient in theTrendelenburg position. Open the abdomen by a free median, rectus or transverse incision. Explorethe abdomen. Push the small intestines out of the way and protect them with moistpads. If the CKCum and sigmoid are easily apposed proceed with the immobility of the caecum impedes approximation, mobilize it by incising the. Fig. 598.—{Lardennois and Okinczyc, Journ. de Chir.) parietal peritoneum along its outer and lower border and raising it as in caecec-tomy. Beware of injuring the ureter. If the sigmoid is immobile divide theperitoneum forming the external or inferior layer of its meson and mobilizeit exactly as the descending colon is mobilized in colectomy but carefully avoidinjury to the vessels. With a fine curved needle introduce the suture shown in Fig. 598 (Larden-nois, and Okinczyc, Journ. de Chir., May, 1913, p. 542). This stitch involvesthe upper or inner layer of the meso-sigmoid, the median parietal peritoneum andsome of the undersurface of the meso-Ueum. It is easy to avoid injury to vessels 442 OPERATIONS ON THE INTESTINES if one picks up the parietal peritoneum with forceps before introducing the needleat any point. Apply a hemostat to each end of the stitch and put it aside. Remove the appendix. Make an anastomosis between the blind end of thecfficum an
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