The Surgical Treatment of Intestinal Obstruction - Tapa blanda

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1888. Excerpt: ... 10. Colotomy. Colotomy mil always retain a place in operative surgery as a palliative and life-prolonging procedure in the treatment of carcinomatous stenosis of the lower portion of the colon, and in cases of inoperable carcinoma of the rectum. The recent advances in abdominal surgeryhave rendered the old-fashioned lumbar or extra-peritoneal operation obsolete. The modern operation is made by opening the peritoneal cavity in the right or left groin according to the indications which are to be fulfilled, and one of its principal objects is to terminate the intestinal canal at the artificial anus so as to provide absolute physiological rest for the portion of the bowel below it. The obvious disadvantages of colotomy, as usually performed, are cited by Maydl as the reasons which induced him to devise the operation which he has described. He opens the peritoneal cavity by Littre's incision, and draws a loop of intestine forward till its mesenteric attachment is on a level with the external incision. Through a slit in the mesentery close to the gut is inserted a hard rubber cylinder wrapped in iodoform gauze; a goose-quill will answer the same purpose. This device holds the intestine in the wound and prevents its return into the abdominal cavity. By means of a row of sutures placed on each side of the prolapsed gut, including the serous and muscular coats, the two limbs of the flexure, in so far as they lie in the abdominal wound, are stitched together beneath the rubber support. If the intestine is to be opened immediately, it is stitched to the parietal peritoneum of the abdominal incision and the latter protected by iodoform collodium. If the bowel is to be incised later, the latter is not stitched to the peritoneum, but surrounded by iodoform gauze packed...