Operative surgery, for students and practitioners . al treatment, rest, etc., fail to control it or if the hem-orrhage recurs and is profuse. Owing to the risk of increasing thehemorrhage the stomach should not be washed out before of body heat must be prevented as much as possible during theoperation. When the stomach is exposed it should be emptied byexpressing the contents onward into the duodenum. Before open-ing the stomach its surface should be carefully examined by inspec-tion and palpation in an effort to locate the ulcer; a puckeringof the surface, thickening of the wal
Operative surgery, for students and practitioners . al treatment, rest, etc., fail to control it or if the hem-orrhage recurs and is profuse. Owing to the risk of increasing thehemorrhage the stomach should not be washed out before of body heat must be prevented as much as possible during theoperation. When the stomach is exposed it should be emptied byexpressing the contents onward into the duodenum. Before open-ing the stomach its surface should be carefully examined by inspec-tion and palpation in an effort to locate the ulcer; a puckeringof the surface, thickening of the wall, or difference in color mayindicate its site. If imable to obtain a clue to the location of theulcer by these means, then the stomach must be incised and itsinner surface systematically explored, first the anterior wall andthen the posterior, and finally the cardiac and pyloric ends. Thisexamination may be made with the naked eye, bringing differentareas of the stomach wall into the incision, one after the other, OPERATIONS UPON THE STOMACH. 367. r0w Fig. 165.—Posterior Wall of Stomach Pushed out through Incision in AnteriorWall by Fingers Passed into Space behind Stomach through Opening in Gastro-colic Ligament. Clamp applied to bleeding point. 368 ABDOMEN AND BACK. or assisted by the introduction of a speculum and the use of areflector. The posterior wall of the stomach may be brought intoview by introducing one or two fingers through a rent in the gastro-colic ligament so as to reach the posterior wall and invaginate it,pushing it forward into the incision in the anterior wall. Thefirst part of the duodenum may also be invaginated and examinedin the same manner. If no ulcer is found and the hemorrhage iscapillary in character or comes from small, indiscoverable ulcers,then a gastro-jejunostomy should be done. If an ulcer can be located it should be excised if possible. Theedges of the wound which is left after the ulcer has been excisedare brought together with catgut su
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