The Abdomen 



183 



No. 40a. Lembert sutnre. 



No. 40b. Lembert BUture. 



No. 41. Halsted's Mattress- 

 suture. 



ENTEROTOMY. 



sition and the cut edges of the mucosa 

 inverted. Halsted's suture is other- 

 wise known as the "mattress stitch." 

 Halsted claims that it is preferable to 

 Lembert's because one row is suffi- 

 cient, it tears out less easily, and con- 

 stricts the tissues less. It is interest- 

 ing to note that several well-known 

 British surgeons have conceded this 

 claim, having observed that the Czerny- 

 Lembert suture generally gives rise to 

 the formation of a ridge in the interior 

 of the bowel which acts as a diaphragm 

 and contracts the lumen. The stitches 

 are inserted about one-third of an inch 

 from the divided edges, and are 

 brought out just free of them. 



Incision of the intestinal wall is performed for the relief of 

 obstruction by fecal concrement or foreign bodies, provided any in- 

 flammatory process that the object has induced is not of such in- 

 tensity that gangrene is threatened, when enterectomy is the only 

 hope of a cure. 



The abdominal cavity being opened and the omentum pushed 

 aside (see Celiotomy), distended loops of intestine usually appear 

 at the wound. These are always on the proximal side of the obstruc- 

 tion. For some distance above, the gut is dilated about one and 

 one-half times, or twice larger than below the seat of obstruction, 



