rectal instruments


By • Дек 19th, 2010 • Category: Colon

Cecostomy is occasionally undertaken to relieve the intestine in the resection of the sigmoid or other parts of the colon and to provide conditions for the healing of intestinal anastomosis when the surgeon has doubt as to its reliability.

The patient is prepared as in colonic operations.

Under combined endotracheal, local or spinal ane­sthesia and in the supine position, a McBurney incision is made as in appendectomy, i. e., with division of the external oblique aponeurosis and splitting by blunt dis­section of the internal oblique and transverse muscles.

After opening the peritoneum, the cecum is exterio­rized, its anterior wall clamped with a soft intestinal forceps (Fig. 153.1), and the wound is isolated with gauze squares.

A purse-string suture -s then applied to the anterior cecal wall by means of j fine round needle, and the wall is stretched outwardly to this suture with a small Billroth or anatomical forceps (Fig. 153.2).

In the centre of the suture the cecal wall is now pierced with a sharp scalpel and a thin rubber catheter (No. 24—26 by the Charriere scale) is inserted into the bowel lumen. Near the catheter the cecal wall is ancho­red to the catheter by a catgut stitch on a small cutting needle (the needle should pierce the catheter wall — Fig. 153.3). The catgut will be absorbed within 10—15 days.

The assistant then buries the catheter together with the sutured cecal wall, while the surgeon tightens and cuts off the purse-string suture. A suction pump is then connected to the catheter.

The peritoneum is now closed so that the sutures take in the cecal wall surrounding the catheter (Fig. 153.4).

The muscles of the abdominal wall will approximate spontaneously. The wound cf external oblique aponeuro­sis is closed with a stout silk or capron (Fig. 153.5). Sutures are then laid on trie skin so that the thread of the central stitch is tied tightly around the catheter base.

In the postoperative period the catheter is connected to a rubber tube, whose other end is led to a bottle sus­pended from the patient’s bed.

Cecostomy operation

Fig. 153. Cecostomy operation:

1. The cecum has been brought out from the wound and compressed with a soft intestinal clamp.

2. A pursestring suture has been applied to the cecal wall. External to the suture, the cecum has been stretched with forceps.

3. A catheter is introduced into the bowel and secu­red to its wall by means of a stitch on the cutting needle which pierces the catheter wall.

4. The peritoneum is sutured securing a margin of ce­cal wall surrounding the catheter.

5. Suture of aponeurosis of the external oblique muscle.

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