184 DISEASES OF THE INTESTINES 



tables, etc., should be supplied. Chickens may be treated with 

 enemas of glycerin, or warm soapy water, and massaging over 

 the abdomen. Fecal masses, calculi or foreign bodies that can- 

 not be evacuated by any of the above methods may be removed 

 by laparotomy and enterotomy. This operation should be 

 performed early before necrosis occurs in which case enter- 

 ectomy must be resorted to and the necrotic portion of the 

 intestine resected (see Enterectomy) . The modus operandi 

 is as follows: Perform laparotomy (see Laparotomy) at the 

 median line just posterior to the umbilicus and withdraw the 

 intestine containing the obstruction. Ligate the bowel with 

 a heavy suture or tape on either side of the obstruction 

 to prevent escape of contents and control hemorrhage by 

 ligating all vessels supplying the part to be operated. Make 

 an incision lengthwise of the bowel opposite the blood supply 

 and of sufficient length to remove the obstruction which 

 must be done carefully. Cleanse the bowel, and suture the 

 mucous membrane, and then the muscular coat with con- 

 tinuous sutures applied very close to the edge and then apply 

 continuous Lembert sutures over these. By suturing the two 

 layers separately, there is less tissue in the part to be folded 

 on by the Lembert sutures. Remove the ligatures from 

 around the bowel and the vessels, cleanse and return to the 

 cavity. 



Constipation due to cicatricial contraction or stenosis may 

 be alleviated by entero-enterotomy. Perform laparotomy 

 as for enterotomy, withdraw the part of the intestine involved 

 and apply a long bowel clamp lengthwise across a curved 

 portion of the bowel, clamping off about three inches above 

 the affected area, and another below, having not less than 

 eight inches between the two clamps. Bring the clamped- 

 off portions in apposition, making a circular loop in the bowel, 

 thus having the peristalsis in the same direction. Apply 

 continuous sutures through the muscular and serous coat 

 of the clamped off portion just above the clamps, bringing 

 the two parts in contact and leave the suture. Make an 

 incision from one to one and a half inches long of same length 

 and position in each bowel. Apply continuous suture over 

 the free edges in contact. Loosen clamps but leave in posi- 



