430 
DEPARTMENT OF SURGERY. 
tine. The pathological condition may be confined to the mu¬ 
cous, muscular or serous coat, but may involve all of them and 
be in such a state that the physiological function hinders na¬ 
ture in its reparatory process. The only course to be taken 
when such a complication is known to exist is to connect the 
part immediately in front of the portion thus affected to some 
part of the alimentary tract beyond the diseased portion, form¬ 
ing an artificial passage for the aliment, which will give rest to 
the part involved, and assist nature in its proclavity. 
Accidental wounds which require a resection of the injured 
portion of the intestine should be treated in this manner, or 
A- ' 
some other commendable method adopted that will relieve the 
portion of the intestine approximated of part of its function and 
avoidable strain ; alleviate pain caused by the contents of the 
alimentary tract passing over the hypersesthetic area surround¬ 
ing the seat of the operation ; lessen the danger of infection as 
a consequence of this contact of aliment with the surgical 
wound ; and, to afford an exit for gas generated and accumu¬ 
lated in the intestine anterior to the point in question. 
To willfully neglect or refuse to inure intestinal anastomo¬ 
sis when indications suggest such interference would be inval- 
orous, while a careful application of this method of easing and 
comforting a patient is often a prodrome to an operator’s reputa¬ 
tion as a surgeon. 
Intestinal anastomozing may be divided, pro forma , into two 
distinct operations; the first (a) a lateral anastomosis, and second 
(b) an end-to-end anastomosis. 
(a) Lateral Anastomosis .—In making a lateral anastomosis 
one division of the intestine is connected with another division 
without interrupting the natural channel by making an incision 
into each and suturing them together, forming an artificial 
opening which connects the lumen of one division to that of 
the other. (Fig. 12.) This opening permits the contents of the 
alimentary canal to pass from one division to the other, and is 
an artificial passage which in time becomes smaller and smaller 
and eventually closes entirely, and in the meantime the in¬ 
testinal tract resumes its normal condition, with but a perma¬ 
nent adhesion of the divisions, which in many cases causes but 
little or no inconvenience to the patient. 
Operation. — The patient must be properly secured and a 
'general anaesthetic administered ; the abdomen is opened, as in 
celiotomy ; the cavity explored and the true condition ascer¬ 
tained ; and, the place selected where the anastomosis is to be 
