The Abdomen 



203 



No. 45a. Ampntatlon of Rectal 

 Brocldeace. First stage. 



No. 45b. Amputation ot Rectal 

 Procldence. Second stage. 



this point. Use the same kind of stitch on the opposite side, and 

 repeat it between these two until a complete circle of interrupted 

 stitches has been inserted and tied, from six to eight generally 

 sufficing for the entire circumference of the gut. The only vessels 

 which require particular attention are the median hemorrhoidal, 

 running on the lateral aspect of the internal tube, and these can be 

 included in one of the sutures. While severing the external tube, 

 the venous branches returning on the serous surface of the 

 external tube, and which are more or less prone to bleed owing 

 to the congested condition of the area they supply, may require 

 to be seized with hemostatic forceps, and so held until the hemorr- 

 hoidal vessels are secured. As soon as the serosa-serosa suturing 

 is completed the occluded side of the intestinal tube, which is now 

 the only part .connected with the procidence, is quickly severed close 

 to the line of sutures with either scalpel or scissors. To complete 

 the operation, approximate the two mucous surfaces with continuous 

 silk sutures, clean the stump and push it back within the anus. 



The best anesthetic to use is chloretone, its prolonged narcotic 

 effect being desirable as tending to allay subsequent straining. 



Hobday inserts a sound or clinical thermometer case within 

 the lumen of the inner layer. Four or five catgut interrupted sutures 

 are passed through the two layers down on to this and back 

 again, and tied close to the sphincter, in order to prevent retraction 

 of the inner layer, and the procidence is amputated. 



Viborg and Stockfleth insert a hollow cone of wood (carrot 

 answers as well) on which there is a groove within the lumen, and 

 then ligate both layers on to this and amputate the occluded por- 



