File:American practice of surgery; a complete system of the science and art of surgery (1906) (14760467561).jpg

Identifier: americanpractic07brya (find matches)
Title: American practice of surgery ; a complete system of the science and art of surgery
Year: 1906 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922
Subjects: Surgery
Publisher: New York, W. Wood and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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thenormal site of the anus, should be estabhshed as soon as the childs conditionwill pemiit. In all cases of this class the fistulous tract should be cut off close 782 AMERICAN PRACTICE OF SURGERY. to its entrance into the rectal pouch, and a ligature should be applied to itsproximal end. This end should then be invaginated into the rectum and shouldbe retained there by Lembert sutures. After the peripheral end has been cleansed,it should be ligatured and left to atrophy. Where the abnormal opening is atsome remote part of the body, it is of course improbable that the rectal pouchcan be reached through the perineum. If a loop of the sigmoid or of the coloncan be brought down and sutured at the anal site, it will probably serve allnecessary purposes. Treatment of Cases in which the Rectum opens into some other Viscus.—Wherethe rectum opens into the bladder (Fig. 321) it is a question of immediate opera-tion ; or death may be looked for in a short time from infection. From a rational
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Fig. 317.—Represents a Case in which the Rectum Opens into the Urethra. standpoint there are open to us two methods of procedure, both of which involveabdominal section. The author believes that such cases should be operatedupon, at the earliest opportunity, by a full and free incision into the abdominalcavity. We are thus enabled to locate the opening into the bladder, and thisinformation will determine w^hat should be the subsequent steps of the operation.Where the opening into the bladder is situated high up and can be reached, itis perfectly feasible to separate the two organs at the point of communication,to invaginatethe openings into each other, and to suture them, provided thereis an external orifice for the escape of fecal matter. If, however, there is animperforate anus, this condition should be remedied first, either by proctoplastyor by colotomy. Where the opening into the bladder is situated low down, inthe neighborhood of the trigone and so far beyond the operators rea

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