CHAPTER XII. 



OPERATIONS ON THE INTESTINES AND 

 ABDOMINAL ORGANS. 



Gastrotomy. — This operation, consisting in the opening of 

 the stomach, is performed for the removal of foreign bodies 

 such as meat skewers, sticks, stones, hat pins, etc., which 

 cannot be got rid of by the aid of an emetic or a purgative, 

 for ulcers of the stomach wall, and for the removal of foreign 

 bodies from the lower part of the oesophagus. The patient is 

 prepared and laparotomy performed as already described, the 

 site of incision chosen being on the median line, just about 

 I or 2 inches below the extremity of the sternum. The 

 stomach is drawn into the wound and surrounded by lint or 

 cloths soaked in antiseptics, the foreign body being brought 

 close up against a portion of the wall where blood vessels are 

 small or absent, and an incision made directly over it. Usually, 

 as soon as the stomach is punctured a certain amount of gas 

 rushes out and carries with it some of the contents ; this may 

 be guarded against by making a preliminary puncture with a 

 fine trocar and canula. Any fluid that does escape must be 

 immediately soaked up before it reaches the peritoneum. 



The foreign body is extracted, the internal edges of the 

 wound are carefully cleansed with antiseptic solution, and a 

 double row of sutures inserted. The first row passes through 

 the whole of the coats, the second Sutures being of Lembert's 

 pattern and inserted through the serous and muscular coats 

 at some little distance from the edges of the wound, so that 

 when drawn together they completely hide the latter, and thus 



