rectal instruments


By • Дек 26th, 2010 • Category: Colon

Under oxygen-ether or azeotropic mixture anesthesia, an incision is made along the midline to open the abdo­minal cavity from the mons pubis to the umbilicus, the sigmoid colon is drawn out and is carefully palpated so as to ascertain the benign nature of the tumour. The sig­moid is then covered with gauze on all sides and com­pressed with soft clamps. A longitudinal incision through serosa is now made along the free taeniae (Fig. 129,1). The sigmoid is opened at the site of incision, one blade of the straight forceps is inserted into the sig­moid lumen, and the sigmoid wall is compressed along the line of the contemplated incision (Fig. 129,2). The sigmoid lumen wall is widely opened with scissors, the sigmoid mucosa is painted with a 2 per cent tincture of iodine, the polyp is pulled out by means of the fenestra-ted forceps, and its pedicle is tied up tightly at its base with tv/o turns of silk thread (Fig. 129,3). No clamps should be applied. If the polyp or villous tumour has a wide base (more than 0,5 cm) it should not be ex­cised from the sigmoid lumen because of the danger of formation of a parietal hcmatoma.

In such occasion the sigmoid resection is the proce­dure of choice.

After the polyp has been removed the sigmoid wound is sutured with silk in two layers (Fig. 129,4), and the abdominal cavity is completely closed.

Colotomy for sigmoid polyp

Fig. 129 Colotomy for sigmoid polyp:

1. A loop of sigmoid has been brought to the outside and covered with moist gauze on all sides. The line of a longitudinal incision along the middle part of taeniae has been marked out.

2. The sigmoid wall is compressed with a straight Billroth forceps along the line of contemplated incision, with one of the forceps blades being in the sigmoid lu­men.

3. The polyp has been extracted, and its pedicle is di­vided with a scalpel over the ligature. No clamp should be applied to the pedicle.

4. The sigmoid wound is carefully sutured in two layers.

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