. American practice of surgery ; a complete system of the science and art of surgery . is better to rely upon carefully placed sutures in the intestine. 758 AMERICAN PRACTICE OF SURGERY. Intestinal Exclusion.—Intestinal exclusion consists in excluding the fiecalcurrent from a portion of the canal by anastomosing the bowel above with thatbelow the excluded segment, without removing the latter. It is resorted tochiefly in cases where a malignant neoplasm, which cannot be removed, isproducing obstruction. The exclusion may be partial or complete. In partialexclusion the proximal loop is divided,
. American practice of surgery ; a complete system of the science and art of surgery . is better to rely upon carefully placed sutures in the intestine. 758 AMERICAN PRACTICE OF SURGERY. Intestinal Exclusion.—Intestinal exclusion consists in excluding the fiecalcurrent from a portion of the canal by anastomosing the bowel above with thatbelow the excluded segment, without removing the latter. It is resorted tochiefly in cases where a malignant neoplasm, which cannot be removed, isproducing obstruction. The exclusion may be partial or complete. In partialexclusion the proximal loop is divided, the ends are closed, and a lateral orend-to-side union is made with the distal loop below. In complete exclusion,both proximal and distal loops are divided and the anastomosis is made as , however, is not—fgr obvious reasons—^to be recommended. Enterostomy.—Enterostomy consists in establishing an artificial communi-cation between the lumen of the bowel and the abdominal wall. The fistulathus formed is named according to the portion of the bowel involved—as, for. Fig. 303.—Mixters Method of Colostomv. example, jejunostomy, ileostomy, colostomy, or sigmoidostomy. The tennenterostomy is generally hmited in its application to the jejunum and procedure is indicated as a means of relief in complete obstruction, or as alife-saving temporary measure in connection with operations upon a patientwhose condition would not warrant the performance of a prolonged radicaloperation. Enterostomy may be made after the manner of a colostomy (to be herein-after described), or the tube of Mixter may be used, in which case the bowel isopened at once and the contents are conducted away without soiling the wound.(Fig. 302.) An ingenious method of accomplishing the same end is describedby Stewart. One-half of a Murphy button is fastened in the bowel in the usualway, the other half being inserted and tied into the end of a rubber tube of suit- SURGICAL DISEASES OF THE IXTE
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