Read Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint)

Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint)

Lewis S. Pilcher

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Description:Excerpt from Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 Of the sigmoid flexure into the rectum. AS soon as we have loosened the bowel at this point, it is remarkable with what ease it will follow on downward traction, more especially when the peritoneum has been incised on both sides of the bowel in the direction of the course of the latter. In doing this I have been repeatedly obliged to sever the two branches of the superior haemorrhoidal artery, which runs in the meso-rectum from the promontory of sacrum towards the upper part of the rectum. I cannot believe that the cutting off of this blood - supply is a matter of indifference, especially when we take into consideration that the superior hmmorrhoidal is, under the existing conditions, alone responsible for the nutrition of the upper end of the bowel, which is deprived of all collateral circulation from the middle and infe rior haemorrhoidal vessels. Its Vitality, moreover, has not been increased by the manipulations necessary to liberate it from the surrounding tissues. It has seemed to me, therefore, that in such cases it is wiser to resect an additional portion of the upper end of the rectum until we are well within the domain of other branches of the inferior mesenteric artery. This is not a difficult task. It is only necessary to incise the peritoneal folds on both Sides of the bowel, which are now the main impediment to down ward traction, and to separate the rectum with the hand from the anterior surface of the sacrum as far as the promontory, if neces sary. The importance of complete relaxation of the sutured ends of the intestine cannot be overestimated. Even when we have attained this end and the rectum lies in the wound cavity without any tension, it later on becomes tense from in ammatory infiltration and perhaps some retraction of the upper end. At the point of resection we are without the guarantee of speedy peritoneal adhesion of the united ends of the bowel. We must depend entirely upon our sutures and the absence of tension for primary union, and how much less will be the chances for it to occur if slight tension already exists at the close of the operation. The part of the bowel most likely to suffer in its nutrition is the posterior distal portion of the upper end. I have a few times Observed circumscribed necrosis at this point, which has, how ever, not interfered with the final complete restoration of the intestinal canal when a temporary anus had been made. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works."We have made it easy for you to find a PDF Ebooks without any digging. And by having access to our ebooks online or by storing it on your computer, you have convenient answers with Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint). To get started finding Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint), you are right to find our website which has a comprehensive collection of manuals listed.
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Description: Excerpt from Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 Of the sigmoid flexure into the rectum. AS soon as we have loosened the bowel at this point, it is remarkable with what ease it will follow on downward traction, more especially when the peritoneum has been incised on both sides of the bowel in the direction of the course of the latter. In doing this I have been repeatedly obliged to sever the two branches of the superior haemorrhoidal artery, which runs in the meso-rectum from the promontory of sacrum towards the upper part of the rectum. I cannot believe that the cutting off of this blood - supply is a matter of indifference, especially when we take into consideration that the superior hmmorrhoidal is, under the existing conditions, alone responsible for the nutrition of the upper end of the bowel, which is deprived of all collateral circulation from the middle and infe rior haemorrhoidal vessels. Its Vitality, moreover, has not been increased by the manipulations necessary to liberate it from the surrounding tissues. It has seemed to me, therefore, that in such cases it is wiser to resect an additional portion of the upper end of the rectum until we are well within the domain of other branches of the inferior mesenteric artery. This is not a difficult task. It is only necessary to incise the peritoneal folds on both Sides of the bowel, which are now the main impediment to down ward traction, and to separate the rectum with the hand from the anterior surface of the sacrum as far as the promontory, if neces sary. The importance of complete relaxation of the sutured ends of the intestine cannot be overestimated. Even when we have attained this end and the rectum lies in the wound cavity without any tension, it later on becomes tense from in ammatory infiltration and perhaps some retraction of the upper end. At the point of resection we are without the guarantee of speedy peritoneal adhesion of the united ends of the bowel. We must depend entirely upon our sutures and the absence of tension for primary union, and how much less will be the chances for it to occur if slight tension already exists at the close of the operation. The part of the bowel most likely to suffer in its nutrition is the posterior distal portion of the upper end. I have a few times Observed circumscribed necrosis at this point, which has, how ever, not interfered with the final complete restoration of the intestinal canal when a temporary anus had been made. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works."We have made it easy for you to find a PDF Ebooks without any digging. And by having access to our ebooks online or by storing it on your computer, you have convenient answers with Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint). To get started finding Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint), you are right to find our website which has a comprehensive collection of manuals listed.
Our library is the biggest of these that have literally hundreds of thousands of different products represented.

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Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint)

Annals of Surgery, Vol. 21: A Monthly Review of Surgical Science and Practice; January-June, 1895 (Classic Reprint)

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