The Abdomen 185 



simplified by placing withing the lumen of the bowel a piece of 

 bread moulded to the shape and circumference of the latter. 



ENTERECTOMY and ENTERO-ENTERAL ANASTOMOSIS 

 or ENTERO-ENTEROSTOMY. 



This operation becomes necessary when a portion of the in- 

 testine has lost its viability. Such condition arises most commonly 

 consequent upon acute intestinal obstruction or strangulation. 



Removal of more than one-third the length of the small gut is 

 dangerous to life. Parkes found that recovery occurred most readily 

 when the portion of bowel resected did not much exceed six inches. 

 Rxperiments showed that extensive resection where the resected 

 portion exceeded one-half the length of the intestinal tract, and 

 where the animals survived the operation, was followed by maras- 

 mus as a constant result, though the animals consumed large quan- 

 tities of food. The operation is a difficult one and demands great 

 precision and attention to detail, but if undertaken in good time, 

 oflfers reasonable hope of success. 



It is highly important to have a clear conception of the blood 

 supply of the bowel. It will be remembered that the intestine is 

 suspended by the mesentery which also supports the blood-vessels. 

 The latter divide some distance from the bowel into two branches 

 and, these by union with neighboring branches form a chain of loops 

 running parallel with the bowel. From these loops are given off 

 terminal twigs to supply the bowel. Most of the twigs run in the 

 muscular coat. Some two inches of bowel include the area supplied 

 by one mesenteric branch. 



There are two operations by which anastomosis may be effect- 

 ed, viz., the end-to-end and the lateral. The end-to-end operation 

 is more commonly performed than the other, but it is not feasible 

 if there is much difference in caliber between the two severed ends, 

 as might occur when a large tract of bowel is excised. There is 

 always risk of subsequent formation of stricture at the site of opera- 

 tion, for the continuity of the muscular wall is broken by a band of 

 inert cicatricial tissue. Myles has pointed out that the contents of 

 the bowel are necessarily forced past this point by mechanical 

 pressure from above and not by contraction. The expansile char- 

 acter of the gut is lost here, and with a sudden and pronounced 

 contraction just above this point the conditions are ripe for an 



