LITHOTOMY 213 



the Czerny-Lembert or Halsted suture. The ab- 

 dominal wound is closed in the usual manner, with 

 interrupted sutures. 



The dangers from this operation are infection, with 

 all its attendant sequelae and shock. These dangers 

 are vastly increased if the fetuses are dead and de- 

 composed. In cases where the fetuses are dead and 

 the uterus shows signs of gangrene, or it is decided 

 that the bitch is not to be used for breeding again, 

 ovariohysterectomy should be performed in prefer- 

 ence to hysterotomy. 



The technic here differs slightly from a simple 

 case of hysterectomy. The blood supply of the preg- 

 nant uterus is greatly in excess of the resting one, 

 and the first step is to ligate both utero-ovarian and 

 uterine arteries. Ligatures are placed as for simple 

 ovariohysterectomy, with the exception that the 

 fundus of the uterus is ligated just behind the bifur- 

 cation and clamped about one inch posterior to the 

 ligature. 



The uterus is then divided between the ligature 



UTERUS WITH CUT EN.D 

 INVAGINATED & SUTURED 



and the clamp, the broad ligament broken down 

 and the cornua, with their contained fetuses, and 

 the ovaries removed. The stump of the uterus is 

 then carefully cleaned and invaginated and sutured 

 with a purse-string suture. Unless this latter step 

 is taken peritonitis almost invariably follows, as it 

 is quite impossible to completely disinfect the uter- 

 ine stump. 



Suprapubic Lithotomy 



The object of this operation is the removal of a 

 vesical calculus. 



