chap, xvn.] THE STOMACH. 303 



Gastrotomy and gastrostomy. Gastrotomy 

 consists in opening the stomach through the anterior 

 abdominal wall for the purpose of removing a foreign 

 body ; gastrostomy in opening the stomach in a like 

 situation with the object of establishing a gastric 

 fistula through which the patient may be fe'd in cases 

 where the gullet is occluded by disease. The un- 

 covered part of the stomach, accessible in these opera- 

 tions, is represented by a triangular area, bounded on 

 the right by the edge of the liver, on the left by the 

 cartilages of the eighth and ninth ribs, and below by a 

 horizontal line passing between the tips of the tenth 

 costal cartilages (Fig. 30). The incision in these opera- 

 tions must be situate in this triangle, and may be made 

 either parallel to, and about two fingers' breadth from, 

 the free border of the costse, or along the left semi- 

 lunar line. In the former incision the three flat 

 muscles of the abdomen are cut through. In gastros- 

 tomy the stomach is not opened at the time of the 

 operation, but is merely secured to the wound, and a 

 few days are then allowed to elapse so that adhesions 

 may form. At the end of this time the viscus is 

 opened. Much difnculty is occasioned by the loose- 

 ness of the mucous membrane, which is apt to pro- 

 trude at the wound by reason of its great laxity. 



Resection of the pylorus. The pylorus is 

 frequently the seat of cancer. As a means of re- 

 lieving the patient of this fatal disease, Billroth and 

 others have removed the whole of the diseased 

 pylorus, and have then united by sutures the cut 

 ends of the stomach and duodenum and closed the 

 abdominal wound. The situation of the cancerous 

 pylorus within the abdomen varies considerably, as 

 the diseased part is very apt to shift its position. It is 

 often found to have sunk down by its weight to a 

 point below the umbilicus, and to have contracted 

 adhesions to adjacent organs. The usual incision is 



