PRaLAPSUS RECTI 69 



be proceeded with in the first instance if the parts 

 are badly torn or show symptoms of gangrene. 



Amputation of the Prolapsed Rectum 



Instruments. — Scalpel, scissors, tissue forceps, 

 eight needles and sutures, a needle holder and ar- 

 tery forceps are the instruments needed for this 

 operatio/i. An antiseptic solution (chinosol 1-1000) 

 must also be provided. 



Operation. — The instruments, needles, sutures, 

 and the operator's hands, having been made surgi- 

 cally clean and the patient under a general 

 anesthetic, H-M-C and choloform by preference, 

 gentle pressure is made of the prolapsed gut 

 and a needle armed with a suture (catgut 

 or absorbent silk) is thrust through the gut 

 from above downwards as close as possible to the 

 anus ; another suture is placed transversely so as to 

 cross the first at right angles. The assistant then 

 holds the ends of the sutures while the operator 

 amputates the gut close behind the sutures. Any 

 hemorrhage is then controlled with the artery for- 

 ceps and the sutures cut at the point of intersection 

 and tied. In this way it is seen that the remain- 

 ing portion of the rectum is secured with four 

 sutures. Sutures an eighth of an inch apart are 

 then put in aU round the gut, the ends cut short, 

 and the parts gently pushed back inside the sphinc- 

 ter ani after being washed in the antiseptic solution. 



After-treatment. — All food must be withheld for 

 twenty-four hours and the diet restricted to slops 

 for at least four days, the bowels up to that time 

 being kept quiet by small doses of opium. Aftet 

 the fourth day, if the patient is uncomfortable, a 

 laxative may be given to produce action of the 

 bowels, and for a month at least the feces must be 



