. American practice of surgery ; a complete system of the science and art of surgery . ^ be opened by a very free incision, which should extendas far as to the posterior commissure; and if there exists a fistulous openinginto the rectum, which is likely to be the case, that also should be laid every instance, great care should be taken to ascertain whether or not there 814 AMERICAN PRACTICE OF SURGERY. is a communication between the abscess cavity and the rectum. Unless sucha channel of communication is opened, the abscess cavity and the connectingtract will not heal permanently. \^^le
. American practice of surgery ; a complete system of the science and art of surgery . ^ be opened by a very free incision, which should extendas far as to the posterior commissure; and if there exists a fistulous openinginto the rectum, which is likely to be the case, that also should be laid every instance, great care should be taken to ascertain whether or not there 814 AMERICAN PRACTICE OF SURGERY. is a communication between the abscess cavity and the rectum. Unless sucha channel of communication is opened, the abscess cavity and the connectingtract will not heal permanently. \^^len these abscesses open spontaneously into the rectum or anus theyconstitute what is known as blind internal fistulie and should be treated as Fig. 329.—The Drawing Shows the Presence of a Retro-Rectal Abscess Above the Line of At-tachment of the Levator Ani Muscle. A, Main cavity of the abscess; B, the point where a fistulaleading from the abscess opens near the anal orifice; C, the point where a second fistula opens intothe lower part of the rectum. (Earle and Tuttle.) There is reason to believe that, when perforation into the rectum does occur,after the abscess cavity has been opened, it is due to imperfect technique inoperating. Probably one of the best means of preventing this accident is tostretch the sphincter ani gently, after opening the abscess cavity. Such stretch-ing relieves the muscular spasm, allows the gases and feces to come away un- SURGICAL DISEASES OF THE ANUS AND RECTUM. 815 obstnicted, and thus relieves the thin rectal wall of any undue pressure. Forthe same reason it is better, after stret(•hin^■ the sphincter, to introduce andleave in the rectum a hync-hs tulje or a piece of stout rul)ljer tubin
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
