320 
PUNCTURE OF THE BOWEL THROUGH THE RECTUM. 
infective material escaping into the peritoneal cavity during withdrawal 
of the canula, some antiseptic fluid may be injected through it into the 
lumen of the bowel. One or two fluid ounces of creolin may be so 
employed, and will also assist in checking fermentation and further 
development of gas. 
The wound is now cleansed, disinfected, powdered with iodoform, and 
covered with adhesive plaster or collodion. As long as the canula 
remains in position, the animal must be watched to prevent it rolling, 
or the instrument falling out. 
Both the skin and intestinal wounds generally close by first intention, 
if antisepsis has been carefully carried out. 
To prevent the bowel falling away from the canula, and to check the 
entrance of bowel contents into the peritoneal sac, Brogniez has constructed 
the so-called enterotome, which consists of a trochar, whose canula is pro¬ 
vided with a pair of projections capable of being opened by pressure after 
insertion; but, as Hertwig has already pointed out, it is unnecessary, as the 
wall of the bowel can only fall away on account of other portions *of bowel 
becoming insinuated between the punctured bowel and the abdominal wall, 
or because of gas forming in the same position, an accident which can 
scarcely occur if, after removing the stilette, the canula is thrust far enough 
in. As Brogniez’s enterotome is of great diameter, and its surfaces are not 
smooth and continuous like those of the trochar, the instrument is not only 
inefficient, but positively dangerous, on account of its favouring the passage 
of intestinal contents into the peritoneal cavity and wound, and increasing the 
risk of peritonitis. In some cases the wings of the trochar have refused to 
collapse, and removal of the instrument from the peritoneal cavity has been 
attended with great difficulty. 
The method proposed by Bourgelat, Chabert, and others, and recently 
revived by Fohringer and Imminger, of puncturing the bowel from the 
rectum, presents a great risk of infecting the peritoneum from the mucous 
membrane of the bowel, a danger which cannot be entirely overcome, even 
by careful antisepsis. 
In the case described by Imminger, rotation of the colon on its long axis 
possibly existed, and after discharge of the gas, underwent spontaneous 
reduction. In such cases, reposition should certainly be first attempted, and 
only where this fails does puncture of the colon appear indicated, though 
even then I should prefer the abdominal walls to the rectum, especially as the 
position of the colon can generally be discovered from the rectum. 
If for any reason puncture through the rectum be considered unavoidable, 
the bowel should as far as possible be emptied, and most carefully rinsed out 
with sublimate solution, as recommended by Imminger. The left hand is 
then passed into the rectum, whilst the right introduces the trochar (with the 
stilette drawn back), and, guided by the left hand, places the instrument on 
the pelvic flexure of the colon, which will be found distended with gas. The 
stilette is then thrust forward with a slight jerk, and the trochar caused to 
enter the colon. For this operation a long curved trochar is indispensable. 
The one used by Imminger has a length of nearly 9 inches, and a diameter of 
-J of an inch, and corresponds to Flourant’s instrument, except in being some¬ 
what thinner. Further procedure is similar to that in puncturing through the 
abdominal wall. 
Pus sometimes forms at the point of operation, by which the danger of 
