Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . r the collection of fecal discharges from a colostomy which has been donewithout the creation of a sphincteric control, or in which the discharges maycome away unexpectedly, cups and sacks have been constructed to be wornconstantly and held over the opening by belts and bands. H. B. Delatour(Med. Record, Nov. 15, 1913) devised such an apparatus of hard rubber,which has attached to it a removable rubber bag (Fig. 1371). This may beworn by the patient who is about o
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . r the collection of fecal discharges from a colostomy which has been donewithout the creation of a sphincteric control, or in which the discharges maycome away unexpectedly, cups and sacks have been constructed to be wornconstantly and held over the opening by belts and bands. H. B. Delatour(Med. Record, Nov. 15, 1913) devised such an apparatus of hard rubber,which has attached to it a removable rubber bag (Fig. 1371). This may beworn by the patient who is about on his feet. Lumbar colostomy has little to recommend it. It is employed in order toavoid traversing the peritoneum; and is aimed usually to open the descendingcolon. The position of the descending colon is represented by a line, passingdirectly upward from a point cm. (% inch) posterior to the middle ofthe crest of the ileum, to the twelfth rib. This line marks the outer border ofthe quadratus lumborum muscle. An incision 10 cm. (4 inches) long, pass-ing obliquely downward and forward has its middle crossing the middle of. Fig. 1371.—Colostomy Apparatus with Fecal Receptacle Devised by Delatour this line. The fibers of the latissimus dorsi, external and internal oblique,are divided. The twelfth dorsal nerve is spared. The border of the quad-ratus lumborum is exposed. The transversalis muscle and fascia are divided,and the subperitoneal connective tissue uncovered. The kidney is pressedupward. If the distended colon does not bulge into the wound, the fingershould loosen the connective tissue toward the psoas muscle, and the patientbe turned so that the wound is rotated downward. The gut may be cleared,grasped with blunt forceps, brought toward the surface, and sutured inthe wound. If the colon has a short mesentery, it may be divided; if thiscannot ^be done the bowel may be divided; or if this is not possible, atransperitoneal operation must be done. Jejunostomy.—This op
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
