Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . optosis, page 710). Closure of Intestinal Fistula (Fecal Fistula, Artificial Anus).—A smallintestinal sinus should be easily closed (see Fistulas and Sinuses, Vol. I, THE ABDOMEN 617 page 304). In addition to the ordinary local treatment, the patient may becaused to fast for a few days or subsist on nutrient enemata. If these meth-ods fail, the sinus may be dissected out, and the intestinal opening such an operation, the skin should be gotten into h
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . optosis, page 710). Closure of Intestinal Fistula (Fecal Fistula, Artificial Anus).—A smallintestinal sinus should be easily closed (see Fistulas and Sinuses, Vol. I, THE ABDOMEN 617 page 304). In addition to the ordinary local treatment, the patient may becaused to fast for a few days or subsist on nutrient enemata. If these meth-ods fail, the sinus may be dissected out, and the intestinal opening such an operation, the skin should be gotten into healthy conditionby keeping it dry, by applying boric acid powder, ointment, or other medica-tion. The operation is done by packing the sinus with dry gauze; sewing itsmouth tightly together with silk; sterilizing the wound area with iodinor chlorin solution; isolating the sinus, without opening it, by an ellipticincision; liberating the bowel with tissue containing the sinus attachedto it; amputating the sinus at its entrance to the bowel, closing the bowelopening with two layers of sutures; and closing the abdomina] Fig. 1261.—Omentum Sewed to Abdominal Wall, Holding Colon in Place. The great omentum, immediately below the transverse colon, is caught to the anteriorabdominal wall with three or four sutures. The bowel is here shown lifted up. When it isreleased and the wound closed it drops below the level of the wound. Later, if necessary, the intestine may be liberated from its adhesion to theabdominal wall. A fecal fistula, having a larger opening, without a spur or without obstruc-tion in the distal arm tends to close spontaneously. If it does not close, itmay be treated as above (Fig. 1262). If it is not desired to expose the peri-toneum, the elliptical dissection may be carried down to the peritoneum butnot through it, and the opening in the bowel sutured. This leaves the bowelstill attached to the abdominal wall, where it may be left, or liberated at asubsequ
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