202 Surgical Diseases and Surgery of the Dog 



consecutive attempts at anal suturing, but with ultimate failure. 

 Finally, he performed celiotomy, and withdrew the bowel through 

 the pelvis. He did not attempt to stitch the bowel to the abdominal 

 wall, and there followed another eversion, and untimately the death 

 of the animal. Of late the Gersuny operation has met with some 

 success. This consists in injecting melted paraffin wax (specially 

 prepared for the purpose) into the submucosal tissue at the anal 

 margin to form pillars which act as barriers to further protrusion. 



Failing replacement by the above simple measures, two opera- 

 tions only offer any reasonable chance of a successful issue. The 

 first and simpler of the two is amputation of the everted portion; 

 the other, celiotomy, withdrawal of the protruding portion, and 

 suspension of the same to the abdominal wall (ventrofixation) by 

 sutures. Amputation may always be recommended, but the other 

 method is contra-indicated where there is present much gangrene. 

 Unless the trouble is remedied by simple measures shortly after 

 its first occurrence and before congestion has taken place, it is 

 generally useless to temporise with simple reduction and anal 

 suturing. To the animal the return of the inflamed and swollen 

 parts must feel of the nature of a foreign body, and efforts are 

 immediately put forth to again bring about its evacuation. How- 

 ever, straining can be prevented for several days subsequently by 

 inducing chloretone narcosis. 



The best method of amputation is as follows: The animal 

 being hoppled in the ventral position and given a general anes- 

 thetic, and the tail being held out of the way by an assistant, grasp 

 the protrusion with fixation forceps and extend it as far as possible 

 from the anus, and apply close to the latter a small rubber band 

 or ligature to act as tourniquet. Make a circumscribed incision 

 through the external intestinal tube parallel to the anal margin 

 and a short distance posterior to the ligature. The internal tube 

 must now be held steady, as but slight traction will pull it away 

 from the peritoneal cavity, which is not desired. Seize the anal 

 margin of the severed external tube, which by this time is much 

 retracted, with the hemostatic forceps and roll it outwards on itself, 

 thus exposing its serous membrane. Pass a fine silk suture threaded 

 to a fine milliner's needle into the serosa and deeper layers of this 

 tube (but not past the submucosa) and out again, and then pick 

 up a similar piece of the inner tube. Tie this stitch and cut the ends 

 off close, thus bringing the two serous surfaces into apposition at 



