. Annals of surgery . Fig. 2. -Diverticulum freed from its attachments and delivered from tlie I. of the omohyoid was cut. Especial care was taken to avoid therecurrent laryngeal nerve and the thoracic duct. The great ves-sels at the base of the neck stood out prominently at the lowerangle of the dissection, which was throughout so dry as not torequire the application of a single ligature. At first no pouchcould be detected. Careful exploration with the blunt dissector (ESOPHAGEAL DIVERTICULUM. 531 between the oesophagus and the vertebrae, however, finally re-vealed it. It was situa
. Annals of surgery . Fig. 2. -Diverticulum freed from its attachments and delivered from tlie I. of the omohyoid was cut. Especial care was taken to avoid therecurrent laryngeal nerve and the thoracic duct. The great ves-sels at the base of the neck stood out prominently at the lowerangle of the dissection, which was throughout so dry as not torequire the application of a single ligature. At first no pouchcould be detected. Careful exploration with the blunt dissector (ESOPHAGEAL DIVERTICULUM. 531 between the oesophagus and the vertebrae, however, finally re-vealed it. It was situated behind the oesophagus, and extendeddownward nearly to the aortic arch (Fig. i). The presentingsurface was grasped with forceps and drawn to the left. The at-tachments of the pouch were, as anticipated, loose, and the sac,easily separated with blunt instnnnents. yielded to moderate trac-. FiG. 3.—Isthmus of diverticulum after excision of its main portion. Tlie cutmargin is grasped by pressure-forceps. In the oesophageal opening the stemof the probang is visible. Case I. tion, until the whole pouch was delivered and projected from thewound at right angles with the oesophagus, to which it remainedattached by only its base (Fig. 2). Even at this time it was diffi-cult to make out exactly the opening of the pouch and its rela-tions with the oesophagus. Dr. Brewer therefore passed a pro-bang into the pharynx, beyond which it was easy, with the finger 532 MAURICE H. RICHARDSON. in the wound, to deflect it by the opening of the pouch. The fun-dus of the pouch was next opened, and the edges of the openingwere grasped with haemostatic forceps. By applying four or fiveforceps, and by spreading this opening (Fig. 3), we could deter-mine the exact extent of the interior of the pouch, the size of itsmouth, its relation to the pharynx and the oesophagus. The baseof tlie pouch was
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
