. Manual of operative surgery. this dissection the operator will think he hasbutton-holed the omentum but usually his fears prove baseless but if thisaccident has occurred it is not of much importance unless a very large hole hasbeen torn. Continue the separation of the omentum upwards until not onlythe colon but the transverse mesocolon as well, lie free from the omentum 28 434 OPERATIONS ON THE INTESTINES which is reflected upwards out of the way. When separation of the omentumfrom the colon is done to gain access to the lesser peritoneal cavity and to theposterior wall of the stomach the la
. Manual of operative surgery. this dissection the operator will think he hasbutton-holed the omentum but usually his fears prove baseless but if thisaccident has occurred it is not of much importance unless a very large hole hasbeen torn. Continue the separation of the omentum upwards until not onlythe colon but the transverse mesocolon as well, lie free from the omentum 28 434 OPERATIONS ON THE INTESTINES which is reflected upwards out of the way. When separation of the omentumfrom the colon is done to gain access to the lesser peritoneal cavity and to theposterior wall of the stomach the layer covering the transverse mesocolon isnot elevated but is divided at or near its colonic attachment. Unless mobiliza-tion of the flexures is necessary or total colectomy is indicated proceed to Step 2.—Mobilization of the ascending and descending colon. Placing thefinger flatly on the mesocolon burrow towards the left under the suspensoryligament of the splenic flexure and divide this avascular peritoneal band. This. Fig. 593.—{Lardennois, Journ. de Chir.) detaches the splenic flexure more easily than is possible by any other the descending colon upwards and continue the incision which mobilizedthe flexure, downwards through the parietal peritoneum close to its reflexionon to the descending colon and with the finger separate the colon from its mobilization of the descending colon and its vessels may be carried outfreely even to a point not far from the middle line. In a similar manner thehepatic flexure and the ascending colon may be mobilized, care being taken toavoid injuring the ureter. COLECTOMY 435 Step 3.—Return the great omentum into the abdomen. Lift the coloninto the air so as to spread out its meson and make its blood-vessels clearlyvisible. If the transverse colon alone is to be excised, doubly clamp the vesselspassing to that part of the gut, divide the meson between the clamps, excisethe desired portion of intestine and restore
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