. Manual of operative surgery. Fig. 619. Fig. 620. KiG. 621. Figs. 619, 620 and 621.—Closure of ftecal fistulas. {Esmarch and Kowalzlg.) Step 3.—Introduce the finger into the belly and explore the relations of theadherent gut to the abdominal wall. Guided by the exploring finger, enlargethe incision, making it run around one side of the fistulous opening (Fig. 620,I,N). Step 4.—^Retract the flap formed by the incision I, N. This exposes thegut and its connection with the inner surface of the parietes at the fistula (, X,Y). Step ^.—Method A.—-If the connection between the gut and the pa

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. Manual of operative surgery. Fig. 619. Fig. 620. KiG. 621. Figs. 619, 620 and 621.—Closure of ftecal fistulas. {Esmarch and Kowalzlg.) Step 3.—Introduce the finger into the belly and explore the relations of theadherent gut to the abdominal wall. Guided by the exploring finger, enlargethe incision, making it run around one side of the fistulous opening (Fig. 620,I,N). Step 4.—^Retract the flap formed by the incision I, N. This exposes thegut and its connection with the inner surface of the parietes at the fistula (, X,Y). Step ^.—Method A.—-If the connection between the gut and the parietes issmall in extent, empty the gut of its contents by stripping it with the fingers,and keep it empty by suitable clamps. Protect the abdomen with pads;divide the union between the gut and the parietes; close the hole in the gut by adouble row of sutures, as is done in enterotomy. Method B.—If the connection between the gut and the parietes when sepa-rated leaves such a defect that simple closure would lead to

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Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921