File:American practice of surgery; a complete system of the science and art of surgery (1906) (14577070398).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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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 and thus prevent SURGICAL DISEASES OF THE AXUS AND RECTUM. 911 wounding the urethra. The peritoneum having been opened, it should be cutback on either side of the rectum until its attachments to the sacrum have beenreached. Before the mesorectal and mesosigmoidal folds of the peritoneumare incised, the cellular tissue between these folds should be loosened from thebone, so that the blood-vessels which it carries may not be wounded in thenext step of the operation, which consists in cutting the peritoneal folds thathold the bowel to the bony frame of the pelvis. Too much tension shouldnever be put on the blood-vessels which support the rectum; and if, uponexerting gentle traction, one finds that it is the blood-vessels and not the meso-
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FxG. 374. -Perineal Extirpation—Loosening Rectiim from Anterior Perineal Rhaphe.ani; R, rectum; M, rhaphe. (Tuttle.) L, Levator rectum which prevent the bowel from coming dowm, he should strip the fatfrom the vessels and clamp the latter before cutting the folds. When the bowel has been pulled down sufficiently to bring the tumor welloutside the anus, the anterior peritoneal opening should be closed hy sutures,the peritoneiun being attached around the bowel well above the tumor. (Fig.375.) The musculature of the perineum should be sewed around the bowel,layer by layer, until the external sphincter is reached. Then this should beaccurately adapted around the whole intestine. Allien this has been done andthe retrorectal space has been packed with gauze, the bowel should be ampu-tated just below the sutures attaching the external sphincter to it. Thisamputation should be made little by little, the mucous membrane being 912 AMERICAN PRACTICE OF SURGERY. grasped by forceps and drawn outs

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