A handbook of intestinal surgery / by Leonard A. Bidwell.

  • Bidwell, Leonard A.
Date:
1905
Catalogue details

Licence: In copyright

Credit: A handbook of intestinal surgery / by Leonard A. Bidwell. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    operation, you will then have to deal with an artificial anus, the treatment of which will be described later. If, on the other hand, the patient's condition is good, an attempt may be made to do an immediate resection of the gangrenous portion of the intestine. To do this it is absolutely essential to open up the ring completely, and to make a free incision into the abdominal cavity. Before doing this the sac must be well cleansed with perchloride of mercury solution, and the ring must be very carefully divided from without inwards, as any introduction of a finger or even director into the ring might cause rupture of the gut. It is therefore better to make a free incision extending up from the sac, and to open the abdomen above the ring, and then to carefully divide this from above downwards and from without inwards. Very great care must be taken when the sac has been laid into the general peritoneal cavity to prevent any fouling of the peritoneum by gangrenous gut. The general cavity should be shut off with towels or large swabs before the gut is lifted up. The gangrenous knuckle is then brought outside the abdomen, and is clamped at least 6 inches above and below the strangu- lated portion. Another two pairs of clamps are apphed close to the strangulated portion. It is very important to remove a considerable amount of bowel on each side of the strangulation, so as to insure that the portion which is joined is quite healthy, and has a proper blood-supply. About 3 inches on each side is the usual amount. The management of the mesentery will depend upon whether the mesenteric vessels are thrombosed. If the vessels are thrombosed, a V-shaped piece of mesentery should be removed with the strangulated knuckle ; if the mesenteric vessels are not thrombosed, the mesentery should be divided close to the bowel, and ah vessels hgatured.