Operative surgery . fter as wellas before operation. Raising the pelvis or foot of the bed facilitates thereturn. The drawing apart of the opening with hooks, catching the bordersof the sac with forcipressure and raising them up in a funnel shape aid thereturn. Other serviceable manreuvres will occur to the _M surgeon at the time. The -M^ omentum is usually removed ^ after ligaturing it in small . \a. - ,. masses, and the stump re-turned entirely into the ab-dominal cavity (Figs. llOliand 1110). The leaving ofomentum in the canal isobjectionable, as it predis-poses to volvulus and con-tributes
Operative surgery . fter as wellas before operation. Raising the pelvis or foot of the bed facilitates thereturn. The drawing apart of the opening with hooks, catching the bordersof the sac with forcipressure and raising them up in a funnel shape aid thereturn. Other serviceable manreuvres will occur to the _M surgeon at the time. The -M^ omentum is usually removed ^ after ligaturing it in small . \a. - ,. masses, and the stump re-turned entirely into the ab-dominal cavity (Figs. llOliand 1110). The leaving ofomentum in the canal isobjectionable, as it predis-poses to volvulus and con-tributes to the return ofhernia. If the gut be muchdiscolored and of doubtfulvitality, divide the constric-tion, withdraw the gut fromits grasp and allow it to remain outside surrounded with Avarm, moist,aseptic dressings. The amount of strangulated intestine depends largely onthe extent of the protrusion. A short loop (Fig. 1111) or only a portion ofthe wall (Fig. 1112) of the gut may be thus involved. If only a small cir-. FiG. 1110.—Tving off omentum, o. Section Ligature being tied. c. Loop for ligaturing. UlKUATKiNS ON NISCKKA lUNNKCTED WITH IEKITUXJ:LM. «J(j7 cumscribetl spot be suspected, it may bo returned just inside of the abdomenand a large drainage tube introduced into tiie inner end of the canal, withtlie idea that the ciiances of final recovery of both gut and patient are im-proved by the latter j)lan. At all events, such seems to be the case. Ifthe patient be kept quiet the relation of the part to the internal ring willchange but little, if at all. But, in the face of vomiting and other physicalmanifestations that disturb the relations of the intestines, the susi)ected })artniigiit readily become removed so far from the opening and the tube as tocause a general peritonitis in case of sloughing, instead of circumscribedadhesion and discharge through the tube as provided for. If gangrene bepresent, and the patients condition and the surgeons preparation will
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