. A manual of operative surgery . has been allowed to form, it must be nickedin two places with a bistoury and stretched with the fingersor dressing forceps. A not infrequent result is prolapse of the intestinal wall,especially if the abdominal wall be flabby or the opening be madetoo large in the muscles. This prolapse after colotomy is tosome patients a most serious drawback. It can be remediedto some extent by the use of a belt and rubber pad ; now and CHAP. IX] LUMBAR COLOTOMY 295 then it will be worth while to perform a second operation, suchas cauterisation of the prolapsed part, narrowi
. A manual of operative surgery . has been allowed to form, it must be nickedin two places with a bistoury and stretched with the fingersor dressing forceps. A not infrequent result is prolapse of the intestinal wall,especially if the abdominal wall be flabby or the opening be madetoo large in the muscles. This prolapse after colotomy is tosome patients a most serious drawback. It can be remediedto some extent by the use of a belt and rubber pad ; now and CHAP. IX] LUMBAR COLOTOMY 295 then it will be worth while to perform a second operation, suchas cauterisation of the prolapsed part, narrowing the orifice bysuture, etc. 2. LUMBAR COLOTOMY Position.—The patient should lie upon the sound side and closeto the edge of the table. A small hard pillow or sand-bag is placedunder the opposite loin, so that the region to be operated upon maybe brought well into view, and the space between the crest of the iliumand the last rib extended to the utmost (Fig. 88). Operation.—First Stage.—The incision should be from three to. FIG. 88.—THE INCISION IN LUMBAR COLOTOMY. is exposed.) The quaclratus lumborum muscle three and a half inches in length. It is placed obliquely, midwaybetween the last rib and the iliac crest. Its centre should correspondto the centre of the line marking the site of the bowel. This line, asshown in Fig. 89, runs vertically down from the tip of the last ribto a point on the iliac crest half an inch behind the middle of thelatter, measuring from the anterior superior spine backwards. The anatomy of the operation is illustrated in Fig. 89. After the skin and superficial structures have been divided theexternal oblique and latissimus dorsi muscles will be exposed. Thefibres of those muscles are in this situation vertical. They should bedivided by a single clean cut through the whole length of the incision. The layer of the internal oblique will next come into view. The 296 ABDOMINAL OPERATIONS [PART II fibres are found running somewhat obliquely upwards
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