Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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res and saves time. Thegut is crushed between the clamps, tied, and divided above this ligature.Next the gut is cut away from the mesentery as far as the part to be resectedextends, and the part thus freed is allowed to hang over the edge of theoperating-table ; the clamp is removed and the upper, distended gut drainsfreely into a suitable receptable while the lower end is being treated. Anyvessels not secured in the cut mesentery are tied and the stump of thelower end of intestine oversewn with purse-string or otherwise to cover inthe Ligated end. By this time a good deal of faeces and flatus will havedrained from the upper free end, and the latter is treated in a similar manner,being crushed above the gangrenous part, tied, and the latter cut away,and then the stomp invaginated. It now only remains to join the twoclosed ends of tin; upper and lower segments by a lateral anastomosis andsew together the mesentery where the gut has been excised ; the latter is 251 A TEXTBOOK OF SURGERY
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Fig. 77. Excision of gangrenous intestine. A. Mesentery tied off, and gut clamped and tied below the gangrenous area. B, Gut divided below the gangrenous part and cut away from its mesentery allowed to force fajcal content into a receiver, while the lower stump is being over-sewn. TREATMENT OF VOLVULUS 255 an important step else a hole is left in the mesentery, a fertile source ofobstruction in the future. Where the gut above and below the obstructionare of equal size (which is unusual) they may be united after the gangrenouspart is removed by end-to-end anastomosis, which has the advantage ofgreater celerity. This plan is said to be followed sometimes by stenosislater : we have found it feasible in but few instances, but in these it answeredadmirably. The mesenteric border requires especial attention in inserting thesutures. Both end-to-end and lateral anastomosis are described in the chapteron General Abdominal Surgery (pp. 99-102). As much as eight or ninefeet of small intestine ha

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