. Manual of operative surgery. Fig. 615.—-Anterior colostomy. [Gould.)Sigmoid withdrawn, mesentery pulled taut and incised. Rectus muscle sewed together between afferent and efferent coils. Step 2.—Split the rectus muscle near its outer margin. Open the abdomen. Step 3.—Deliver a loop of the sigmoid as in Step 2, Method G. Step 4.—Split the meso-sigmoid for about 2 inches at a right angle to thelong axis of the bowel. Suture the two edges of the middle portion of theseparated rectus muscle together through the opening in the meso-sigmoid(Fig. 615). 458 OPERATIONS (JN THK INTESTINES Step 5.—Pus
. Manual of operative surgery. Fig. 615.—-Anterior colostomy. [Gould.)Sigmoid withdrawn, mesentery pulled taut and incised. Rectus muscle sewed together between afferent and efferent coils. Step 2.—Split the rectus muscle near its outer margin. Open the abdomen. Step 3.—Deliver a loop of the sigmoid as in Step 2, Method G. Step 4.—Split the meso-sigmoid for about 2 inches at a right angle to thelong axis of the bowel. Suture the two edges of the middle portion of theseparated rectus muscle together through the opening in the meso-sigmoid(Fig. 615). 458 OPERATIONS (JN THK INTESTINES Step 5.—Push the reflected flap of skin and rectus fascia tlirough the open-ing in the meso-sigmoid and suture it in its original position (Fig. 616). After four or five days the exposed coil of sigmoid may be resected, whenbleeding from the cut ends of the intestine may be controlled h\ a continuoussuture of catgut. The proximal and distal openings are wide a[)art and the. Fig. 616.—Anterior colostomy. [Gould.)Flap fastened into original position under arch of sigmoid, with two layers of sutures. Mixtertube in place rectus acts as a sphincter. Through the distal opening it is easy to flush therectum (Fig. 617). If obstruction is acute one may open the bowel in Step5 and insert a glass tube (Pauls tube; Mixters tube). Method I.—Littlewoods Colostomy.—Make a vertical incision from the tipof the twelfth rib on the left side downwards to a point behind the anteriorsuperior iliac spine. Expose the descending colon and open it as far back aspossible on its outer side so as to leave no chance for the small intestine tofind a niche in which it may become strangulated. This operation has anumber of important advantages. The new anus is far from hairs and hence COLOSTOMY 459 is comparatively sanitary. Almost any belt around the waist will suffice tohold an occlusive pad in position. Method J.—McGavins Transversostomy (Clin. Soc. Trans., 1906; Brit.
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