. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 250.—Appendectomy. The appendix buried. The muscular coat isseparated from the peritoneal by blunt dissection. abdominal cavity should be very carefully performed beforeinterfering with the caecum or the mass of adhesions in which theappendix is buried. Sometimes one wall find the anteriorabdominal wall adherent to the mass beneath the incision, inwhich event packing can be dispensed with, but any opening inthe wall of adhesions should be carefully plugged, both to pre- 54^ DISEASES ASSOCIATED WITH GYNJECOLOGIC L
. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 250.—Appendectomy. The appendix buried. The muscular coat isseparated from the peritoneal by blunt dissection. abdominal cavity should be very carefully performed beforeinterfering with the caecum or the mass of adhesions in which theappendix is buried. Sometimes one wall find the anteriorabdominal wall adherent to the mass beneath the incision, inwhich event packing can be dispensed with, but any opening inthe wall of adhesions should be carefully plugged, both to pre- 54^ DISEASES ASSOCIATED WITH GYNJECOLOGIC LESIONS vent leakage of pus into the healthy peritoneal cavity and pro-trusion of healthy gut into the infected region. If there are nosuch adhesions the abdominal cavity should be protected, below,toward the median line, and above, by a sufficient number ofsponges to prevent contamination. It is true that intra-abdom-inal pressure will usually cause all pus to flow outward, but the. Fig. 251.—Appendectomy. The appendix buried. The entire appendix isbrought out minus its peritoneal coat. collapse of a large abscess cavity, when the patient is anaesthe-tized and the muscles relaxed, might allow pus to escape into thegeneral peritoneal cavity. The mass should be broken into with the finger, which seeksout the lines of least resistance between the coils of adherent APPENDECTOMY 549 gut, and it often happens that the appendix can be quickly out-lined, especially in cases which have lasted but three or fourdays. If it cannot thus be found, the anterior cecal band shouldbe traced to its base, and adhesions gently pushed away as thefinger outlines the appendix, until it can be demonstrated as
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