ENTEROTOMY AND ENTERECTOMY 



405 



small intestines, the bowel is cut through transversely in 

 the healthy part on each side of the lesion. 



The first step in the execution of such procedures is to 

 return all of the viscera into the cavity except the part to be 

 operated upon, and then prevent them from constantly push- 

 ing through the incision by temporarily sewing it up with 

 one or two interrupted sutures until the work is completed 

 and the repaired portion is ready to be returned. 



In ordinary enterotomies for the removal of foreign ob- 

 jects an incision is made just long enough to allow the object 

 to be pressed through, but such incision should be made in 

 adjacent healthy parts and not directly over the object where 

 local inflammation caused thereby may interfere with heal- 

 ing. Closing the incision with a Czerny-Lembert suture of 

 catgut completes this part of the procedure. 



Fig. 204— Erfterotomy. A, B, Transverse Incision. 

 C, Longitudinal Incis'on. 



Enterectomy is much more complicated and necessitates 

 first the application of the clamps on each side of the lesion, 

 one-half of an inch from the proposed lines of incision. 

 Next the nutrient vessels supplying the part between the 

 clamps are isolated with the view of ligating only those which 

 supply the part to be excised. The nutrition of the adjacent 

 portions must not be impaired by promiscuous ligation, be- 

 cause good nourishment will be needed to assure healing 

 of the approximated ends. The establishment of collateral 

 circulation will not come to the rescue soon enough. 



The clamps being applied and the vessels ligated with 

 catgut the exclusion of the diseased section of bowel includ- 

 ing the mesentery within the ligatures may then be executed 



