THE ABDOMINAL CAVITY 301 



Gastro-Enterostomy. When the stomach fails to empty 

 itself efficiently owing to pyloric obstruction, atony, or for any 

 mechanical reason, the condition may be improved by the 

 operation of gastro-enterostomy, with or without additional 

 complete closure of the duodenum. In the presence of gastric 

 or duodenal ulceration associated with hyperchlorhydria, the 

 same operation may be performed to provide a new outlet from 

 the stomach, thus giving to the ulcer the necessary rest from 

 irritation ; at the same time it permits the bile to enter the 

 stomach and neutralise the hyperacid gastric contents. 



The operation of choice is the method known as " Posterior, 

 no loop, antiperistaltic gastro - jejunostomy." When the 

 abdomen has been opened, preferably in the median plane, 

 the duodeno-jejunal flexure and the first few inches of the 

 jejunum must be identified. The greater omentum and 

 transverse colon are drawn out of the abdomen with the left 

 hand, until the transverse meso-colon is rendered tense, and 

 the latter is then traced backwards to its attachment with the 

 right hand. On the left side of the vertebral column and 

 immediately below the transverse meso-colon the fingers 

 encounter the first coil of the jejunum ; this is withdrawn 

 through the wound, and in the process the duodeno-jejunal 

 flexure is recognised by its fixation. The surgeon then makes 

 an opening in the greater omentum below the gastro-epiploic 

 vessels, and, passing his left hand into the omental bursa, holds 

 the transverse meso-colon tense. With his right hand he then 

 divides the latter fold for at least two inches in a vertical 

 direction. Through this opening, which is made to the left of 

 the middle colic artery (p. 338), the surgeon passes the proximal 

 piece of the jejunum into the omental bursa with his right hand. 

 Maintaining the gut in its original direction, he draws it out 

 with his left hand through the opening in the greater omentum 

 (Stiles). A long intestinal clamp is applied along the extended 

 loop of bowel, after it has been emptied by massage. At this 

 stage the transverse colon and greater omentum are replaced 

 in the abdominal cavity and the postero-inferior surface of the 

 stomach is turned out through the opening in the latter. The 

 site for anastomosis is selected, preferably the most dependent 

 part of the greater curvature, and a second clamp is applied 

 transversely to this area of the stomach. The anastomosis is 

 carried out, and finally allowed to drop back into the omental 

 bursa. After the opening in the greater omentum has been 



