348 
MULTIPLE LIGATION. 
often followed by extensive contraction of the anus and difficulty in 
defecation, and most practitioners, therefore, prefer amputation. 
(2.) Ligation has been adopted by Yiborg and Stockfleth in the case 
of pigs, dogs, and foals. As it is necessary to keep the anus open for 
the passage of feces, Stockfleth binds a ring of wood, 1 to 2^ inches in 
diameter, in the anus ; to prevent the ligature slip¬ 
ping off, the ring has a shallow groove on its surface 
(fig. 156). The prolapse is divided up to the anus, the 
ring then thrust in, and a stout ligature passed 
around it and the prolapsed bowel, which slowly cuts 
through, until finally the portion of intestine beyond 
the ring is cut off. During the next few days defeca¬ 
tion must be assisted by clysters, and bulky and 
indigestible foods avoided. The tube falls away 
spontaneously in five or six days, and as a rule heal¬ 
ing is then complete. Sorensen in this way ampu¬ 
tated a piece of bowel, weighing 23 ounces, in the 
horse. A case of Johne’s, however, in the pig, shows that after ligation 
stenosis, and even complete occlusion, may occur. 
(3.) Multiple ligation. If the layers of bowel are not completely united 
to one another, or at any rate not firmly adherent, there is consider¬ 
able risk of opening the peritoneal cavity when practising this method. 
Fig. 156. — 
Stockfleth’s wooden 
ring. 
Figs. 157, 158.—Method of ligation in prolapsus recti. 
The simple cobbler’s stitch is often recommended. A transverse 
incision is made through the upper half of the protruded bowel, close 
behind the anus, and the two layers of tissue in front of the incision 
united by closely applied ligatures. The lower half is then divided and 
the ligaturing continued, until finally the protruded portion of bowel is 
completely divided and removed. The simultaneous division and ligation 
prevents the end of the bowel not yet firmly fixed by sutures slipping 
back into the peritoneal cavity, and producing fatal peritonitis. 
