rectal instruments


By • Дек 18th, 2010 • Category: Colon

This operation is similar to that for cancer of the sig-moid colon in emaciated patients (see p. 274 and Fig. 173.2 and 3). It is indicated for patients in a state of severe cancerous intoxication, patients with disturbed regenera­tive processes, and in very obese individuals. All these cases involve so great a risk of anastomotic suture line being dehisced (even if a cecostomy is made) that the surgeon is compelled, to save the life of the patient, to remove the tumour and perform a loop colostomy.

With the patient lying supine and under endotracheal anesthesia with ether and oxygen or with azeotropic mix­ture, a transverse incision of the abdominal wall is made (see Fig. 177.1), with division of both rectus muscles. The omentum is then brought out of the abdominal ca­vity together with the transverse colon, separated from the latter in an area free of vessels (Fig. 179.1), and at once resected transversely over the bowel between two clamps along the course of the gastrocolic ligament. If the tumour has infiltrated the omentum, the infiltrated area should be circumscribed and left on the bowel, after which the latter is pulled out of the abdominal cavity, its mesentery is dissected under the tumour for a distan­ce of 10—12 cm between clamps (care being taken not to injure the middle colic artery), and both bowel limbs are sutured together at the base with 3 fine sutures (Fig. 179,2) along a free taenia.

The peritoneal edges of the transverse wound are then sutured to the skin edges around the bowel circumferen­ce. The suture ends are not cut off (see p. 277, Fig. 174.3), the exteriorized loop is sutured all around the ab­dominal wound (Fig. 179,3), and the entire transverse wound of the abdomen is closed in layers both to the right and to the left of the loop. The bowel limbs are next clamped with straight forceps at a distance of 3 cm from the stoma and cut off (Fig. 179.4). The loop base is wrapped with an ointment strip. The clamps are remo­ved in 24 hours.

Resection of exteriorized transverse colon with formation of loop colostomy

Fig. 179. Resection of exteriorized transverse colon with formation of loop colostomy:

1. The omentum is detached from the transverse co­lon in a vessel-free area.

2. Both limbs of the bowel are sutured at the base with 3 fine sutures along free taenia.

3. The externalized loop of transverse colon is su­tured to the edges of abdominal wound.

4. Both limbs of the colon are cut off over clamps at the level of 3 cm from the skin surface

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