Operative surgery, for students and practitioners . e after the operation. If the gut is badly damaged or very much thickened about theperforation or presents several openings close together it may be wiseto resect the affected portion and restore the continuity of the gutby an end-to-end anastomosis; a better plan under these conditionswould probably be to draw the damaged coil of gut out of the abdomenand fix -it to the edges of the incision with several non-penetratingsutures of chromic catgut and thus establish an intestinal fistula (seeEnterostomy). If it is found at the time of operation
Operative surgery, for students and practitioners . e after the operation. If the gut is badly damaged or very much thickened about theperforation or presents several openings close together it may be wiseto resect the affected portion and restore the continuity of the gutby an end-to-end anastomosis; a better plan under these conditionswould probably be to draw the damaged coil of gut out of the abdomenand fix -it to the edges of the incision with several non-penetratingsutures of chromic catgut and thus establish an intestinal fistula (seeEnterostomy). If it is found at the time of operation that the soiling of theperitoneum has been general it may be advisable to turn the entiresmall intestine out of the abdomen in order to cleanse the peritoneal OPEEATIONS UPON THE SMALL INTESTINE. 421 cavity either by wiping with dry, sterile gauze pads or else by irrigatingwith saline solution; after the intestines have been treated in a similarmanner they are returned to the abdomen. Drainage is arranged inthese cases as already indicated Fig. 192.—Enterectomy. A loop of intestine has been drawn out ttiroughthe abdominal incision and tied off with tapes. The mesentery correspondingto the portion of gut that is to be excised has been tied off in sections. Thedotted lines indicate the lines of section through the mesentery and gut. Enterectomy.—Eesection of a portion of the gut (small intes-tine) ; the length of gut resected may vary from several inches toseveral feet. The operation is performed for wounds which may notbe safely closed by suture; for those associated with division of the 422 ABDOMEN AND BACK. mesenteric vessels, especially if they are divided close to the intestine;for malignant growths; for gangrene, strangulation; for fistula, etc. The incision is usually made in the middle line, four or five incheslong, reaching from the umbilicus downward toward the symphysis orcorresponding to the location of the fistulous opening if one is portion
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