82 RUMENOTOMY 



through the oblique muscles of the abdomen. It should 

 begin at the upper commissure of the gaping skin wound 

 and follow a line equidistant from the wound margins to 

 the lower commissure. Finally the peritoneum is to be 

 picked up with forceps, punctured carefully with a scalpel, 

 and the opening suflBciently enlarged. 



Another and probably preferable plan for making the 

 laparotomy wound is to incise the skin as directed in the 

 preceding paragraph, and then separate the external oblique 

 muscle obliquely downward and forward between its muscu- 

 lar bundles, and the internal oblique in a corresponding 

 manner obliquely downward and backward, the two pene- 

 trations crossing in their middle, X-formed. The peri- 

 toneum is then incised as in the preceding plan. By this 

 technic, suturing of the, peritoneum and muscles after com- 

 pleting the operation is quite unnecessary. Only cutaneous 

 sutures are advisable. 



If the rumen is distended with gases, liquids, or solids, 

 it immediately prolapses somewhat through the laparotomy 

 incision. The margins of two or more thicknesses of sterile 

 gauze should now be introduced between the rumen and the 

 wound margins as illustrated in Fig. 30. Make an incision 

 through the walls of the rumen 6 to 8 inches long, imm.e- 

 diately beneath, and parallel to, the laparotomy wound. 

 Seize the lips of the wound in the rumen promptly with 

 four heavy artery or dressing forceps, one upon either lip at 

 the lower commissure, the other two at the upper 

 angle. By drawing steadily upon the forceps, assistants 

 may draw the invaded portion well out of the wound as 

 shown, and can hold the walls of the rumen backward, 

 forward and downward in such a manner that no aliment 

 can readily escape and drop into the peritoneal cavity. 

 In default of needed assistants, the operator may make a 

 heavy fixing suture in the adjacent skin, pass the free ends 

 of the suture through the forceps' handles, and tie them 



