. The Journal of laboratory and clinical medicine . about 4 em. on each side of the point of entrance of the common bile 81 TECHNIC FOR MAKING A BILIARY FISTULA 85 duct into the duodenum and between the duodenal wall and the must be taken in making- these openings not to injure the pancreas andthe blood vessels going from the pancreas to the duodenum, and in makingthe lower opening not to injure the major pancreatic duct. Through theseopenings the peritoneum and, later, the fascia are sutured with double No. 2chromic catgut. This procedure leaves the duct-bearing portion of the d
. The Journal of laboratory and clinical medicine . about 4 em. on each side of the point of entrance of the common bile 81 TECHNIC FOR MAKING A BILIARY FISTULA 85 duct into the duodenum and between the duodenal wall and the must be taken in making- these openings not to injure the pancreas andthe blood vessels going from the pancreas to the duodenum, and in makingthe lower opening not to injure the major pancreatic duct. Through theseopenings the peritoneum and, later, the fascia are sutured with double No. 2chromic catgut. This procedure leaves the duct-bearing portion of the duo-denum just under the skin (Fig. 1). The superficial fascia and the skin arethen sutured over the transposed loop of intestine (Fig. 2). In closingaround and over the upper and lower ends of the loop care must be taken notto cause too much jDressure as obstruction may be produced. After completehealing has taken place, which requires from seven to fourteen days, at asecond operation a small incision is made over the point of the transposed loop. Fig. 1.—The first part of the duodenum pulled out into the wound and the peritoneum and fasciasutured through the openings made in the mesentery, thus fixing it firmly in position with the bile ductpartially exposed. ,J<?CAA/Y\iT^__^
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Keywords: ., bookcentury1900, bookdecade1910, booksubject, booksubjectmedicine
