. Manual of operative surgery. the end of the ileum to the side of the colon as described inthe following paragraphs. Repair the wound in the peritoneum (peritonealization) (Fig. 586). To dothis it may be necessary to mobilize the parietal peritoneum on both sides ofthe raw surface left by the removal of the caecum. Unless the peritoneum ismobilized and freed from the ureter when sutures are inserted and tied, theureter may be kinked. Jamison and Dobson (Lancet, April 27, 1907) have made a very thoroughstudy of the lymphatic system of the cfficum. The relation of the lymphaticstraining the cae
. Manual of operative surgery. the end of the ileum to the side of the colon as described inthe following paragraphs. Repair the wound in the peritoneum (peritonealization) (Fig. 586). To dothis it may be necessary to mobilize the parietal peritoneum on both sides ofthe raw surface left by the removal of the caecum. Unless the peritoneum ismobilized and freed from the ureter when sutures are inserted and tied, theureter may be kinked. Jamison and Dobson (Lancet, April 27, 1907) have made a very thoroughstudy of the lymphatic system of the cfficum. The relation of the lymphaticstraining the caecum and ascending colon to the ileo-colic vessels is shown inFig. 587- C^CECTOMY 427 Another niethod ol opcraUug is as follows: — Step I.—Open the abdomen freely through the right rectus muscle. Applyan abundant protecting jnick of gauze to the median side of the colon. Step 2.—Incise the parietal peritoneum along its line of reflection on to thegut throughout the whole length of the outer side of the ascending colon. By. Fig. 588.—Mobilization of caecum and ascending colon. Note duodenum and ureter exposed. (Mayo.) finger and gauze dissection raise the caecum and colon from their bed and con-tinue the dissection inwards so as similarly to mobilize the ileo-colic vessels,the lymphatic vessels and nodes along with the peritoneum covering them onthe median side of the mobilized gut (Fig. 588). The ureter and part of theduodenum are exposed by the dissection. If in case of carcinoma the ureteris involved it may be removed and the kidney with it. Doubly ligate the ileo- 428 OPERATIONS OX THE INTESTINES colic vessels high up. Similarly ligate them low down, not far from theirjunction with the superior mesenteric vessels supplying the terminal ileum. Step 3.—Apply two crushing clamps to the ileum about three inches fromthe ileocecal valve and divide it between the clamps with the cautery. Step 4.—From below up divide the mesentery of the caecum and and separa
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