Operative surgery, for students and practitioners . ofthe bowel is accomplished largely by blunt dissection with the freeing the rectum upon its anterior aspect, the pouch ofperitoneum which dips do-oTi upon its front wall, between it and theuterus and vagina in the female and the bladder in the male isencountered. It may be necessary to open the pouch, and, indeed,this is probably desirable in all cases, since the bowel can then bebrought down with much more ease. After the opening has beenmade in the peritoneal pouch it may be enlarged by cutting withthe scissors, upon either side
Operative surgery, for students and practitioners . ofthe bowel is accomplished largely by blunt dissection with the freeing the rectum upon its anterior aspect, the pouch ofperitoneum which dips do-oTi upon its front wall, between it and theuterus and vagina in the female and the bladder in the male isencountered. It may be necessary to open the pouch, and, indeed,this is probably desirable in all cases, since the bowel can then bebrought down with much more ease. After the opening has beenmade in the peritoneal pouch it may be enlarged by cutting withthe scissors, upon either side, close to the wall of the rectum. 37 578 RECTUM. Through the opening which is thus made two fingers are introducedand the bowel pulled down. After the bowel has been pulled downas far as necessary the edge of the opening in the peritoneum maybe sewed to the peritoneal layer of the sigmoid flexure with plaincatgut suture, thus closing off the peritoneal cavity; or else the peri-toneal pouch may be left open and packed with gauze. If the peritoneal. Fig. 259.—Resection of the Rectum (Kraslte). The rectum has been exten-sively detached and drawn out of the incision and ligated well above the upperlimits of the disease. It is divided above the ligature as indicated by thedotted line. The lower, anal portion is packed with iodoform gauze. fold is involved in the disease it may be already obliterated by itsopposing surfaces having become agglutinated, or the growth mayhave extended still farther so as to involve the uterus or will add to the difficulty of the operation; but some surgeonsdo not consider it a counter-indication to the continuance of theoperation, because, if necessary, the parts of these organs that are OPERATIONS UrON THE ANUS AND RECTUM. 579 involved may be resected. If the peritoneal fold is not involved inthe di.^ease it can usually be peeled away from the front wall of therectum with the finger, and in this case the operation may be com-pleted with
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