FOREIGN BODIES IN THE STOMACH 151 



all the tissues down to the peritoneum. Considerable care 

 should be taken in going through this in order to avoid 

 puncturing the abdominal organs. It is best to grasp a 

 small part with forceps and clip it out with the scissors, 

 making an opening large enough to insert the probe pointed 

 bistoury and with this enlarge the incision the desired length 

 which depends on the operation to be performed and on the 

 size of the operator's finger. One and one-half inches is 

 sufficient for most cases, although it may be made large 

 enough in a large dog to admit the entire hand. Absorbent 

 cotton or a pledget of gauze moistened with antiseptic solu- 

 tion is useful to keep the wound free from blood, but none of 

 the antiseptic fluids should be allowed to enter the peri- 

 toneal cavity. Sterile water should be used to cleanse any 

 portion of the viscera or peritoneum exposed . To suture the 

 laparotomy wound, use medium-sized silk or linen suture 

 material and make interrupted sutures about one-quarter to 

 three-eighths of an inch apart depending upon the thickness 

 of the abdominal wall. Using a long, slender, full curved 

 needle, start about one-quarter of an inch from the margin 

 of the wound, and pass it through the muscle and peritoneum, 

 having the index finger inserted in the wound to prevent 

 the needle entering the viscera, particularly the intestine or 

 bladder, and bring it out on the other side at the same dis- 

 tance from the margin so that when tied, and swelling occurs, 

 one edge will not be forced above the other. The surgeon's 

 knot, i. e., wrapping the first half of the knot twice, should 

 be used, and if omentum is forced out when suturing it may 

 be pushed back with blunt forceps as the knot is being tied. 

 To avoid a hernia following this operation, be sure that the 

 sutures pass through all the layers of the abdominal wall, 

 i. e., skin, muscle, aponeurosis, and peritoneum. 



Gastrotomy.— Perform laparotomy, as above, in the median 

 line and about one-quarter of an inch posterior to the xiphoid 

 cartilage, making the incision about two and a half inches 

 long. Grasp the stomach with the thumb and finger and 

 draw it out as far as possible. Pack it securely with sterile 

 cotton squeezed out with sterile water, or with dry sterile 

 gauze to prevent any of the stomach contents from entering 



