Operative surgery . nd death, or a persistent fistula. Surfaces thus exposed maybe repaired with omental grafts or inversion and union of the serous bor-ders with sutures. Adhesions maybe so dense as to be irremediable. Omen-tal adhesions can be readily stripped or tied off as their condition suggests. The Preccmtions.—In omental oozing it is a quicker and securer methodof practice to ligature and remove the omentum containing the bleedingarea at once than to catch and tie separately the bleeding points. Adhe-sions should be dealt with nnder direct observation when possible, in orderto note th
Operative surgery . nd death, or a persistent fistula. Surfaces thus exposed maybe repaired with omental grafts or inversion and union of the serous bor-ders with sutures. Adhesions maybe so dense as to be irremediable. Omen-tal adhesions can be readily stripped or tied off as their condition suggests. The Preccmtions.—In omental oozing it is a quicker and securer methodof practice to ligature and remove the omentum containing the bleedingarea at once than to catch and tie separately the bleeding points. Adhe-sions should be dealt with nnder direct observation when possible, in orderto note the presence of any ill effect from their rupture. It will be neces-sary for this purpose, in many instances, to spread out the adherent mass asmuch as possible before attempting the separation, which can then be donesafely with scissors in the instance of fibrous bands, Ilwmorrhage.—The occurrence of persistent bleeding before or after theclosure of the abdominal wound are often complications of profound signifi-. FiG. 777.—Ari:i!ii;einent of the tissues corresponding to the lower fourth of the rectusmuscle (below the semilunar fold of Douglas). cance, especially the latter. If all bleeding points be tied at once and oozingbe arrested the dangers of this complication are reduced to a minimum, itis wise to restore the patient to the normal dorsal position, and perhaps topermit the return of the viscera to their normal relations in order that theinfluences of posture and warmth on their circulation may be estimated, andthat any threatening outlook may be anticipated and remedied before the45 612 OPERATIVE SURGERY. final closure of the abdominal wound. If hfemorrhage happen afterward,prompt exposure of the field of operation, removal of the blood clots, andarrest of hemorrhage is indicated. In such cases as these indecision andcontentment on the part of the medical attendant contribute greatly to fatalissues. The Cleansing of the Peritoneal Cavity.—^\oo([, urine, bile, feca
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