. Surgery, its principles and practice . effected by the use of chemicals,such as silver nitrate. The actual cautery may be required if epitheliumhas formed. The chances of success are greatest where no epitheliumlines the tract and where the artificial tube is long and narrow. If a mechanical obstruction exists, it is often necessary to relieve theimpediment to the fecal circulation. A flexion or spur may be treatedby the old enterotome of Dupuytren or its modified and improved formas given us by Blasius. This instrument has for its purpose the forma- INTESTINAL FISTULA. 677 tion of adhesions
. Surgery, its principles and practice . effected by the use of chemicals,such as silver nitrate. The actual cautery may be required if epitheliumhas formed. The chances of success are greatest where no epitheliumlines the tract and where the artificial tube is long and narrow. If a mechanical obstruction exists, it is often necessary to relieve theimpediment to the fecal circulation. A flexion or spur may be treatedby the old enterotome of Dupuytren or its modified and improved formas given us by Blasius. This instrument has for its purpose the forma- INTESTINAL FISTULA. 677 tion of adhesions between parts of the bowels not previously agglutinated,but which nevertheless form part of the coil in question; and, in the secondplace, the destruction of so much of the walls of the bowel as will enablethe feces to pass by a deeper and more direct route from above uncertainties and dangers of the instrument in application to thesecases are obvious. It is far better under most conditions to resort to a plastic operation. Fig. 375.—Dupuytrens Enterotome. for the closure of the opening. Attempts may be made to close the fistulaby suturing the intestinal wall without opening the peritoneal attempts, however, are as a rule unsuccessful, on account of thepresence of so much infectious matter. The stitches slough out, thepressure of intestinal contents overcomes the resistance of the weak,new connective tissue, and the fistula is re-established. Intestinal anastomosis withthe exclusion of the part in-volved may be employed, butonly in extraordinary cases,where simpler, more directmethods are applicable. Resection of the bowel withre-establishment of its contin-uity after opening the freeperitoneal cavity must in fu-ture be limited to very excep-tional cases. We agree with Senn thatthe method suggested by himwill obviate the necessity ofresorting to these graver pro-cedures except in the most ex-traordinary cases. The procedure of preliminary transver
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