. A manual of operative surgery . nstances, the rule should always beobserved to keep throughout very close to the appendix, whichmust be followed as a guide. In detaching an adherent appendix an abscess cavity maybe discovered. It will probably communicate with the should be well sponged out, and its walls gently surgeons attach importance to dusting the involved areawith an antiseptic powder, such as iodoform, aristol, etc. Thevalue of this procedure is very doubtful, and it may even do harm. chap, xiii] EXCISION OF VERMIFORM APPENDIX 411 In certain of these cases, but
. A manual of operative surgery . nstances, the rule should always beobserved to keep throughout very close to the appendix, whichmust be followed as a guide. In detaching an adherent appendix an abscess cavity maybe discovered. It will probably communicate with the should be well sponged out, and its walls gently surgeons attach importance to dusting the involved areawith an antiseptic powder, such as iodoform, aristol, etc. Thevalue of this procedure is very doubtful, and it may even do harm. chap, xiii] EXCISION OF VERMIFORM APPENDIX 411 In certain of these cases, but not in all, a drain will be considerable amount of pale-yellow, custard-like materialmay be found about an adherent appendix. It should be care-fully scraped away. Caseous glands, if readily isolated, shouldbe removed whenever possible. Treatment of the Pedicle.—As the appendix is being isolated,care should be taken to demonstrate its pedicle. The pediclerepresents the meso-appendix, or at least the source of the blood. FIG. 115.—SECTION OF VERMIFORM APPENDIX FROM A YOUNG ADULT. [After Testut.) i, Peritoneal coat, reflected at i as the meso-appendix ; 2, Subperitoneal coat, with vesselsand longitudinal muscle fibres ; 3, Circular muscular coat; 4, Submucous layer ; 5,Mucous layer, with glandular crypts, tubules, and closed follicles; 5, Muscularismucosae; 6, Tubular glands ; 7, Lymphoid follicles ; 8, Lumen of appendix. supply of the appendix (Fig. 115, 1/). There may be no meso-appendix. The appendix may derive its blood supply directfrom csecal arteries, or direct from adhesions. It may be suppliedapparently wholly from adherent omentum. Sometimes theappendix is found to be fibrous and shrunken, and in such caseits blood supply may be very small. Such an appendix may beremoved without securing any vessels by ligature, but this isvery rarely the case. In an uncomplicated case the appendix and its mesentery 412 ABDOMINAL OPERATIONS [part ii are readily brought out
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