. Manual of operative surgery. Fig. 655.—Showing the crushed area of thebowel after removal of the clamp. A ligature is passed through the mesocolonclose to the bowel on either side of the crushedarea, and tied firmly. The interrupted line in-dicates the incision to be made through thecrushed bowel and adjacent portion of themesocolon. (Illustration taken from Mr. ErnestMiles paper in the British Journal of Surgery,October, 1914.), MILES OPERATION 509 reflexion in the pelvis. These incisions are in the posterior parietal peritoneumon each side of the meson and i inch from it. This gives access
. Manual of operative surgery. Fig. 655.—Showing the crushed area of thebowel after removal of the clamp. A ligature is passed through the mesocolonclose to the bowel on either side of the crushedarea, and tied firmly. The interrupted line in-dicates the incision to be made through thecrushed bowel and adjacent portion of themesocolon. (Illustration taken from Mr. ErnestMiles paper in the British Journal of Surgery,October, 1914.), MILES OPERATION 509 reflexion in the pelvis. These incisions are in the posterior parietal peritoneumon each side of the meson and i inch from it. This gives access to lymphaticswhich extend under the peritoneum to each side of the meson. Pull the distal. ^K-^tKiVf^ • Fig. 656.—Showing complete division of the pelvic mesocolon and_ligature of the inferiormesenteric artery at the seat of portion of the bowel on the left-hand side is that from which the colostomy is eventually incision in the peritoneum, carried forward on the left side, exposes the left ureter as it crosses theleft common iliac vessels. The ureter is drawn aside while the ligature is placed around the inferior mesen-teric vessels. (Illustration taken from Mr. Ernest Miles paper in the British Journal of Surgery, October,1914.) segment of colon forwards and open the connective-tissue space in front of theconcavity of the sacrum. By finger and gauze dissection, from above down-wards, detach the rectum (ensheathed in the fascia propria recti) along with its ;io THE RECTUM meson, blood-vessels and lymphatic glands from the ligamentous structuresin front of the sacrum (Fig. 657). Carry this separation down to the level of the sacro-coccygeal articul
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Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
