. The Journal of laboratory and clinical medicine . be easily lo-cated^-). The transplantation of the duodenum is accomplished by rotatingits axis to the right, and approximating the two edges of the abdominal wallunder the duodenum by means of four single mattress sutures, Xo. 2 chromiccatgut, which include both fascia and peritoneum (two sutures to each sidewdth the location of the duct at about the middle of the incision). Openingsjust sufficient for the duodenum to pass through snugly, but without constric-tion, are left at the upper and lower ends of the wound. In the rotation of theduode
. The Journal of laboratory and clinical medicine . be easily lo-cated^-). The transplantation of the duodenum is accomplished by rotatingits axis to the right, and approximating the two edges of the abdominal wallunder the duodenum by means of four single mattress sutures, Xo. 2 chromiccatgut, which include both fascia and peritoneum (two sutures to each sidewdth the location of the duct at about the middle of the incision). Openingsjust sufficient for the duodenum to pass through snugly, but without constric-tion, are left at the upper and lower ends of the wound. In the rotation of theduodenum a small portion of the pancreas is brought out of the abdomen andthereby the entrance of the duct into the gut becomes very superficial. Themattress sutures pass through this portion of the pancreas in an oblique direc-tion; the head of the needle is passed first in order not to injure blood Aesselsby the sharp point, and comes out at the juncture of the intestine and theright layer of the mesoduodenum. At each of these points a portion of the. Fig. 1.—The diuxleiuim traii^plaiiU-il (uitsiilc the ahiioniinal cavity with the iiKijnr pancreatic duct stillill situ preiiaratory to the establishment of the tistuhi. bowel wall is included in the sutures for secure anchorage. The sutures aretied and the abdominal cavity shut off from the field of operation (Fig. 1). The skin on the right of the initial incision is reflected in its central por-tion for approximately 1 cm., depending on the amount of room needed forthe easy reception of the duodenum which is brought over to the right andfitted into the cavity thus made. Catgut sutures passing through the perito-neal and muscular coats of the intestine and through the superficial fascia ofthe abdominal wall are inserted to maintain the bowel in its new position, Tlie pancreatic duct is dissected free for the short distance wdiich it runsobliquely beneath the serosa of the gut and is partially severed at the pointwhere it enters the
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Keywords: ., bookcentury1900, bookdecade1910, booksubject, booksubjectmedicine
