File:Manual of operative surgery (1921) (14784516675).jpg

Identifier: manualofoperativ1921binn (find matches)
Title: Manual of operative surgery
Year: 1921 (1920s)
Authors: Binnie, John Fairbairn, 1863-1936
Subjects: Surgery, Operative
Publisher: Philadelphia : Blakiston
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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. Step 9.—Attend to the toilet of the peritoneum. Introduce two or threepints of warm saline solution into the abdomen. Close the wound. Applydressings. Step 10.—Place the patient in the right dorsal semiprone position. Closethe anus by a purse-string suture. Make the incision shown in Fig. 660.Open the sacro-coccygeal articulation and remove the coccyx. Make a small33 5^4 THE RECTUM transverse incision into the dense connective tissue immediately below thesacrum, where the attachment of the fascia propria recti can readily be detachedfrom the front of the lowermost piece of the sacrum. Thrust the index fingerinto this and so into the space containing the isolated bowel. Divide thecoccygei muscles transversely on each side, extending the cuts outwards as faras the sacro-sciatic ligaments (Fig. 66i). Pull the bowel out through thiswound. If in the earlier stages of the operation the anterior connections ofthe rectum have been separated down to the prostate, the base of the bladder.
Text Appearing After Image:
Fig. 661.—Showing the pelvic colon and the isolated upper part of the rectum withdrawn from the cavity of the pelvis. If the isolation of the rectum has been efficiently carried out anteriorly, posteriorly, and laterally, thebowel can be readily withdrawn, in the manner shown, and the base of the bladder, the vesiculae seminales,with the vasa deferentia and the prostate gland, are clearly exposed to view. The levatores ani are thendivided close to their origin from the pelvic wall. (Illustration taken from Mr. Ernest Miles paper inthe British Journal of Surgery, October, 1914-) the vesiculae seminales, the vasa deferentia and the upper part of the prostate,come into view. In the female, the uterus and upper half of the vagina areexposed. Pull upon the bowel and thus put the levatores ani on the stretch.Divide them close to the lateral wall of the pelvis. If these muscles do not comeinto view on traction being made it is because the lateral ligaments of the rectumhave not been suffic

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