The Abdomen 223 



formed by the posterior border of the last rib and the transverse 

 process of the first lumbar vertebra. The muscular tissue is then 

 divided by blunt dissection down on to the peritoneum. The index 

 finger being introduced within the wound is made to disengage the 

 peritoneum, but without puncturing it. Between it and the psoas 

 muscles lies the kidney. The latter is brought out through the 

 wound and grasped between the thumb and index finger of the left 

 hand, and is ready for the next operative step. This method is not 

 suitable when much enlargement of the gland exists, in which case 

 the transperitoneal method should be followed, the opening in the 

 wall being made anterior to the umbilicus. 



For either operation the animal should be securely hoppled 

 in either the lateral or dorsal position and given a general anes- 

 thetic. 



NEPHROTOMY. NEPHROLITHOTOMY. 



Section of the kidney is undertaken for the extraction of cal- 

 culi and the parasitic Eustrongyle. The operation has been suc- 

 cessfully performed by Tuffier, Legueu, Thomassen, and Rubay for 

 the extraction of concretions. A longitudinal incision is made at 

 the convex border, where vascularity is at a minimum and hemorr- 

 hage, as a rule, insignificant. Superficial vessels of large caliber 

 traverse both faces of the gland, but do not anastomose at the 

 border. The incision is carried through to the pelvis. In case of 

 much bleeding (Tuffier experienced this on one occasion) it can 

 be arrested by a stream of water and compression of the renal 

 artery between thumb and finger. Every vestige of concretion is 

 then removed. Large alkaline concretions sometimes have branches 

 extending into the calyces, which increase the difficulty of their re- 

 moval. These are best freed by passing a blunt instrument around 

 them. In cases of acid concretions the ureter should be sought 

 and a probe passed down into its lumen into the bladder to make 

 sure that no stone is lodged in it. 



The pelvis can also be opened by direct incision, but this posi- 

 tion is seldom selected, as a wound thus made is usually followed 

 by the formation of a serious fistula. 



Tuffier and Thomassen closed the organ with three or four 

 catgut sutures. If sutures are used they must not be tied very 

 tight, so as to destroy any renal tissue and provoke the formation 



