334 SURGICAL APPLIED ANATOMY. [Chap.xvn. 



pyloric cancer be too large or otherwise unsuited for 

 removal, the canal of the alimentary passage may be 

 restored by gastro-enierostomy. Here the stomach is 

 exposed. An incision is made in its long axis 

 about two inches from the greater curvature, a con- 

 venient coil of small intestine (jejunum) is taken, is 

 opened along its free border, and the mai-gins of the 

 gastric and intestinal openings are then adjusted. 

 Food can now pass from the stomach to the bowel 

 without^passing the pylorus. Loreta's operation. In 

 cases of non-malignant stricture of the pylorus, the 

 stomach has been opened and the stricture successfully 

 dilated by two fingers introduced through the wound. 

 After the dilatation, the gastric and abdominal wounds 

 are closed. 



The small intestines.* The average length of 

 the small intestine in the adult is 22| feet, the ex- 

 tremes being 30 feet and 15 feet. In the foetus, at 

 full term, the lesser bowel measures about 9| feet. It 

 is roughly reckoned that the first 8 or 9 feet of the 

 adult bowel belongs to the jejunum, and the remain- 

 ing 12 or 13 feet to the ileum. 



The division into jejunum and ileum is quite arbi- 

 trary. There is no one point where it can be said 

 that the jejunum ends and the ileum commences. 

 When the small intestines are exposed by accident or 

 operation, it is often difficult, especially when there 

 is abdominal disease, to recognise the upper from the 

 lower part of the gut. It may be noted, however, 

 that the jejunum is wider than the ileum (its diameter 

 being a quarter of an inch greater than that of the 

 ileum), and its ooats are thicker and more vascular. 

 If the gut be empty, and can be rendered translucent 

 by being held against a light, the lines of the valvuhe 



* The account of the intestines is derived from the Author's 

 work "On the Intestinal Canal and Peritoneum in Man. " London, 

 1885. 



