. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 279.—Enterostomy, Insertion of purse-string suture and tube. of the intestine, the abdominal incision thoroughly protectedwith rubber dam and sponges, the intestine opened, a tube quicklyinserted, and the purse string tied. The purse string preventsleakage for a day or two, after which time sufficient adhesionshave formed to protect the peritoneal cavity. If opening of INTESTINAL OBSTRUCTION: ENTEROSTOMY 633 the intestine can be deferred for 24 hours it is safer to do so,when a simple incision with the cautery is
. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 279.—Enterostomy, Insertion of purse-string suture and tube. of the intestine, the abdominal incision thoroughly protectedwith rubber dam and sponges, the intestine opened, a tube quicklyinserted, and the purse string tied. The purse string preventsleakage for a day or two, after which time sufficient adhesionshave formed to protect the peritoneal cavity. If opening of INTESTINAL OBSTRUCTION: ENTEROSTOMY 633 the intestine can be deferred for 24 hours it is safer to do so,when a simple incision with the cautery is made through theconvex surface of the protruding loop, to give vent to the re-tained gas and liquid contents of the intestine. It is the habit of some operators to establish a fecal fistulafor practically all cases of post-operative obstruction, but asthis necessitates still another operation of gravity it shouldbe avoided when at all Fig. 280.—Enterostomy. Diagram showing tube in place for temporarydrainage of gut. Fecal Fistula.—Fecal fistulae follow pelvic operations lessfrequently in the practice of those who never use is not because drainage causes fistula, but rather becauseintestinal perforation in the closed abdomen is so promptlyfatal that fistula does not result. It must be admitted, however, that the old glass drains didcause an occasional fistula, but soft rubber tubes and gauzedo not. 634 POST-OPERATIVE COMPLICATIONS AND SEQUELS Fecal fistulae are the result of enterostomy for obstruction,of operative accident, of pre-operative perforation of a pus tubeor other abscess into the intestine, or of such damage to thebowel wall that sloughing takes place. Those fistulae whichmake their appearance soon after operation are more likely toclose spontaneously than those appearing later, as the formerare usually due to injury, while the latter are caused by slough-ing and actual loss of tissue.
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