i6o Surgical Diseases and Surgery of the Dog 



GASTB0T0M7. 



This operation is performed for the delivery of foreigfti bodies 

 from the interior of the organ. It is also sometimes necessary in 

 order to extract bodies which have found lodgment in the lower 

 third or thoracic portion of the esophagus. 



To reach the organ, open the abdomen in the median line 

 immediately posterior to the xiphoid appendage, and extend the in- 

 cision as far as the umbilicus. Grasp the organ and draw it out 

 as far as possible. When empty, it is separated from the abdominal 

 wall by parts of the liver and small intestine, and is covered with 

 omentum. When distended, it comes in contact with the abdominal 

 wall. Pack it securely with sponges and cloths round the part to 

 be incised to prevent escape of its contents into the peritoneal 

 cavity. If the animal has been fed a short time previously the 

 walls are seen to be intensely injected, but if it has fasted they are 

 pale. Before making the incision insert a couple of "securing" 

 stitches on either side of the contemplated opening, by which the 

 organ may be easily retained outside the cavity. These stitches 

 must not penetrate the mucosa. The walls are thick and vascular, 

 but the larger vessels can be avoided by making the opening mid- 

 way between the greater and lesser curvature, and at right angles 

 to the long axis. The organ may be opened with a sharp pointed 

 curved bistoury, or it may be punctured with this instrument first 

 and an enlargement made with scissors. When the muscular coat 

 is divided it contracts and becomes considerably inverted, and this 

 causes projection of the mucosa. The latter bleeds very easily 

 on slight irritation. 



The delivery of sharp or hard bodies must be accomplished with 

 very careful manipulation. Hobday recorded a death from rupture 

 of the posterior aorta, occurring during removal of a hard piece of 

 gristle from the lower part of the esophagus by way of the stomach. 



The margins of the opening are united by continuous suture, 

 of catgut or silk, throughout all the coats. The wound is then in- 

 verted by bringing the serous borders into apposition with a second 

 row of mattress or Lembert silk sutures, which must not penetrate 

 the mucosa. Lastly, the "securing" stitches and cloths are removed 

 and the. organ allowed to slip back into the cavity. 



Sutures and suturing of the wall of the alimentary canal will 

 be foimd more fully described under Enterorrhaphy. 



