. A manual of gynæcology and pelvic surgery, for students and practitioners. 252.—Appendectomy. Clamping the mesentery. before. In an old abscess case in which the appendix forms anintegral part of the median wall, and in old retro-cecal abscesseswhich are best opened extraperitoneally, it may be injudiciousto seek the appendix at all, both because the peritoneal ca^^tywill be badly contaminated and because absorption from these 550 DISEASES ASSOCIATED WITH GYNECOLOGIC LESIONS surfaces is extremely rapid, but these cases seem to grow morerare as ones experience increases. Ligation of the
. A manual of gynæcology and pelvic surgery, for students and practitioners. 252.—Appendectomy. Clamping the mesentery. before. In an old abscess case in which the appendix forms anintegral part of the median wall, and in old retro-cecal abscesseswhich are best opened extraperitoneally, it may be injudiciousto seek the appendix at all, both because the peritoneal ca^^tywill be badly contaminated and because absorption from these 550 DISEASES ASSOCIATED WITH GYNECOLOGIC LESIONS surfaces is extremely rapid, but these cases seem to grow morerare as ones experience increases. Ligation of the Mesentery and Treatment of the Stump.—Themesentery should be ligated in one or more sections, dependingupon its length and thickness. Clamping may precede the. Fig. 253.—Appendectomy. The mesentery severed. ligature if the mesentery is readily drawn up, but with a shortfat mesentery, or one friable from oedema, it is safer to tie insitu, snipping away as much as has been safely ligated. Veryshort stumps, and loosely placed ligatures and sutures, have noplace in the removal of an appendix unless one wishes to reopenin the middle of the night to stop hemorrhage. Care is neces- APPENDECTOMY 551 sary in ligating the mesentery not to catch the wall of the ileum,or kink the ileum at its junction with the caecum. Before the appendix is amputated the intestine and abdom-inal incision should be protected with sponges, else local periton-itis with subsequent adhesions, or abscess in the abdominal wall,is bound to follow in a fair proportion of cases.
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