406 VETERINARY SURGICAL OPERATIONS 



by simply making a transverse section one-half of art inch 

 from each of the clamps. The ends are then approximated 

 and united by Czerny-Lembert sutures of catgut. 



The Czerny series is first completed around the entire cir- 

 cumference of the bowel; then, without removing the clamps, 

 the Lembert series is placed, leaving the stitch untied until 

 all have been inserted. They are then all tied consecutively 

 except one on each side of each protruding end of the clamps, 

 which are left open to allow the withdrawal of the clamps 

 which, save the protruding ends, are buried by the infolded 

 edges of the bowel. The clamps are then withdrawn and 

 the remaining four stitches are tied. 



Fourth Step. — Replacing the Sutured Intestine and Clos- 

 ure of the Incision. — The intestine thus reunited is now re- 

 placed in the cavity after removal of the temporary sutures 

 in the abdominal incision, which is then closed by means of 

 the "removable buried suture." (See page 106.) 



AFTER-CARE. — In order to arrest all peristaltic move- 

 ments which would prevent union, the patient is given, per 

 os, several doses of laudanum at different times during the 

 first forty-eight hours after the operation, and the function 

 thus suspended must not be revived for twelve days, at which 

 time a laxative is administered. Only small amounts of liquid 

 food are allowed during this interval, and the allowance of 

 solid food must be limited until the end of the third week. 



When such operations are not emergent the adminis- 

 tration of opiates should precede them. 



SEQUELS. — i. Shock is is a common occurrence in in- 

 testinal operations. It follows immediately the revival 

 from the anaesthetic and is manifested by rigors, coldness of 

 the periphery, whining, weak pulse, inability to stand, and 

 pallor of the visible mucous membranes. The treatment 

 consists of the administration of ammoniacal stimulants, sub- 

 cutaneous injections of normal salt solution, and above all 

 the application of a taut abdominal bandage. 



2. Peritonitis supervening three to four days after the 

 operation indicates errors in asepsis. Its occurrence may 

 necessitate drainage of the wound to evacuate septic prod- 

 ucts. Internally quinine, iron, and nux vomica are indicated. 



3. Perforation of the intestinal tube through failure of 

 the approximated ends to unite after enterectomy, or of the 

 incision of enterotomy, is the most serious mishap, and in 

 animals is generally fatal owing to the improbability of suc- 

 cess from a second operation. 



