Stomach; Small Intestine 323 



the treatment should consist in careful dieting, and in the frequent 

 washing of the dilated viscus by means of a soft rubber-tube, a funnel, 

 and hot water. 



Gastrostomy is, literally, cutting a mouth (arco/u-a) in the stomach, 

 and is resorted to in impassable stricture of the oesophagus, that the 

 patient may be permanently fed thereby. Cutting into the stomach, as 

 in the removal of a foreign body, is gastrotomy. 



Gastrostomy may be done through the left linea semilunaris. The 

 incision is begun close below the ribs and is continued downwards 

 for 4 in. The peritoneum being opened, the left lobe of the liver 

 is seen ; behind it is the front of the stomach, which is then drawn 

 up and secured to the margin of the wound, where it soon becomes 

 fixed by adhesion of the opposed surfaces of peritoneum. (The 

 sacculated and movable transverse colon could best temporarily be 

 mistaken for the smooth and fixed stomach.) In performing gastro- 

 stomy the viscus need not be opened straightway, but may be fixed 

 to the abdominal wound for a few days by harelip pins to diminish 

 the risk of fluid entering the peritoneal cavity. 



Another method of operating, and one which gives more room, is 

 by a three-inch incision which, beginning at about i in. to the left of 

 the linea alba, runs parallel to and about an inch below the cartilages of 

 the left ribs. The outer part of the rectus and its sheath, and, of course, 

 the oblique and the transverse muscle, are divided, the transversalis 

 fascia and the peritoneum are opened, and the lower border of the 

 stomach is brought to the wound and secured. 



The stomach in all these operations is generally very small, and is 

 hidden beneath the left lobe of the liver, or high in the phrenic dome, 

 and the surgeon, seeing the transverse colon along his incision, is apt 

 to take it at first sight for the stomach. The appendices epiploicag 

 and the longitudinal bands, however, soon show that he must look 

 higher for the stomach, which he finds by passing his fingers round 

 the liver, up to the transverse fissure, and down the lesser omentum. 

 The great omentum descends from the lower border of the stomach. 



Digital dilatation of the pylorus (Loreta) has been successfully 

 employed in cases of fibrous contraction, which is usually diagnosed 

 from the cancerous form by the lengthy and quiet course which the 

 disease has run, and by the absence of a definite tumour in the right 

 hypogastric or epigastric region. The stomach having been found 

 through the oblique incision just given, and the pylorus having been 

 drawn out of the wound, an opening is made on the anterior surface 

 of the lesser end, away from all large vessels, and, the pylorus being 

 steadied by the left hand, the right index and then the index and 

 middle fingers are gradually worked through the orifice. The wound 

 is then closed with Lembert's sutures and the stomach is dropped 

 back. 



The small intestine is about 20 feet long, hung from the spinal 



Y2 



