File:American practice of surgery; a complete system of the science and art of surgery (1906) (14761346794).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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(EarleandTuttle.) ^ ^^^^T s; G, Rydygiers; //, Hegars 910 AMERICAN PRACTICE OF SURGERY which projects beyond the ligature is cauterized with pure carboHc acid or withthe actual cautery. The external sphincters are next dissected from their at-tachment to the rectum and drawn away to the sides by retractors; they arethen split anteriorly to the perineal body, and posteriorly to the coccyx. (Fio-.373.) The latter incision is carried well up along the right side of the coccyxinto the retrorectal space. The fingers are then carried into this space, and therectum, with all the cellular tissue, is separated from the anterior surface ofthe sacrum as high up as the promontory. The mass of cellular tissue is thenpeeled off on each side of the rectum, from above downward, as far as to the
Text Appearing After Image:
Fig. 373.—Perineal Extirpation of the Rectum. (Quenu-Tuttle Metiiod.) iJ, Rectum; £•, exter-temal sphincter; C, coccyx; T, transversus perinei muscles; A, bulbous urethra. (Tuttle.) attachment of the levator ani muscle, which is then grasped ^\dth forceps, andcut over the finger on both sides of the rectum, thus loosening all the lattersattachments except those which bind it to the perineal body and prostate, orthe vagina, in front. These tissues and the ano-bulbar rhaphe having beencut through, the rectum is freed throughout its entire circmnference, and thesuperior pelvi-rectal space is entered. (Fig. 374.) The cellular tissue may bedissected with scissors or torn off with the fingers. Just above it, is foundthe peritoneal cul-de-sac, which may be stripped up in some cases, but shouldalways be opened if the neoplasm extends above it. (Fig. 375.) In males, before dissecting the rectum loose from its perineal attachments,one should introduce a urethral sound to serve as a guide a

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