. Diseases of the rectum and anus: designed for students and practitioners of medicine. be divided in order to resect the growth and liberate thebowel sufficiently to bring the proximal end down to unite itto the distal. To accompHsh this it sometimes suffices to severthe lateral peritoneal attachments; but it may be necessary toseparate the peritoneum from all sides of the rectum. In suchcases the mesorectum binding it to the sacrum should be dividedas far as possible from the bozvel, in order to avoid severing the 558 DISEASES OF THE RECTUM AND ANUS nutrient vessels. After the anastomosis ha
. Diseases of the rectum and anus: designed for students and practitioners of medicine. be divided in order to resect the growth and liberate thebowel sufficiently to bring the proximal end down to unite itto the distal. To accompHsh this it sometimes suffices to severthe lateral peritoneal attachments; but it may be necessary toseparate the peritoneum from all sides of the rectum. In suchcases the mesorectum binding it to the sacrum should be dividedas far as possible from the bozvel, in order to avoid severing the 558 DISEASES OF THE RECTUM AND ANUS nutrient vessels. After the anastomosis has been completed,if the field of operation is clean, the peritoneum should bestitched to the serous coat of the bowel; if there is dangerof infection, the peritoneal cavity may be drained with wound is now irrigated and gauze placed about thebowel to insure free drainage. The skin-flap is replaced andsutured, allowing space for the gauze drains. The rectum isloosely packed with antiseptic gauze to protect the woundwithin the bowel, and dressings are applied to the external. Fig. 179.—Showing Method of Amputating the Rectum After it has beenFreed from its Attachments in Superior Proctectomy. wound and secured with a T-bandage. The patient is placed inbed, with instructions to the nurse to keep him quiet, admin-istering opiates, if necessary. When the growth is low and itcan be extirpated by removing the coccyx only, the writerprefers the posterior median incision of Kocher. When it is desirable to form an osteo-integumentary flap, thesame preliminary incisions are made. The ligamentous andmuscular attachments are severed on the left side of the sacrumand coccyx up to the transverse skin incision and also from thetip and anterior surface of the coccyx. The sacrum is divided TREATMENT OF MALIGNANT TUMORS 559 on a line just below the third sacral foramina as before de-scribed, and the bone and attached soft parts turned back to theright (Fig. 178) and held by an assista
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
