File:Operative surgery, for students and practitioners (1913) (14592887709).jpg

Identifier: operativesurgery1913mcgr (find matches)
Title: Operative surgery, for students and practitioners
Year: 1913 (1910s)
Authors: McGrath, John J. (John Joseph), b. 1866
Subjects: Surgery, Operative
Publisher: Philadelphia, Davis
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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he fold divided in front of the clamp, between the clamp andthe rectum. The clamp has the superior hemorrhoidal vessels in itsgrasp. The rectum may now be pulled down freely out of theincision. The rectum is drawn out until a portion of the sigmoidflexure, well above the disease, can be brought down into the analmargin without tension. Occasionally the mesosigmoid is quite shortand resists the effort to- pull down the end of the bowel, and it maythen be necessary to still further clamp and divide the mesosigmoid 672 RECTUM. before the desired part of the rectum can be brought down withouttension. In making the additional incision into the mesosigmoidthe cut should be made as close as possible to its root (line of attach-ment to the sacrum) in order to avoid injuring the terminal branchesof the sigmoid arteries which are necessary for the supply of thebowel. All vessels that have been clamped are ligated and the edge ofthe peritoneal fold which was cut away from the front of the rectum
Text Appearing After Image:
Fig. 254.—Amputation of the Rectum (Quenu). The recto-vesical fold ofperitoneum has been incised and the bowel drawn down, far out of the inci-sion, so that the sigmoid flexure presents in the incision. B., bulb of the urethra;P.P., edges of the recto-vesical fold of peritoneum; PR., prostate gland; 8.,sigmoid flexure. is sutured with plain catgut stitches to the front and sides of thebowel—sigmoid flexure, thus closing the peritoneal cavity. Theincisions in the perineum are closed with interrupted silk stitchesand the anterior and posterior ends of the external sphincter care-fully and accurately sutured together. The lower, diseased part ofthe bowel is amputated, and the end of the sigmoid sutured to theedges of the anal margin, all around, with silk sutures placed quiteclose together, spaces of one-half inch between them. A rubber tube wrapped around with gauze is introduced into OPERATIONS UPON THE AXUS AND RECTUM. 573 the rectum to permit the escape of gas, etc. A gauze strip

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