Identifier: americanpractic07brya (find matches)
Title: American practice of surgery ; a complete system of the science and art of surgery
Year: 1906 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922
Subjects: Surgery
Publisher: New York, W. Wood and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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akea permanent inguinal anus and to close up the lower end of the colon entirely. Fi-nally, where the rectum communicates with the urethra, the need for interference SURGICAL DISEASES OF THE ANUS AND RECTUM. ■83 is generally not so urgent. The condition is more favorable for operation, owingto the fact that the rectal pouch, in these cases, is always located lower downand nearer the pelvic floor. It is best to dissect down upon the rectal i)ouch,disconnect it from the lucthra, and bring the orifice through which its contentsare discharged into the urethra, back to the normal ))osition of the anus, whenit can be enlarged to any extent necessary and sutured to the margin of the skinin this locality. After the rectum is detached from its connection with theurethra, a simple perineal fistula is left, and this lesion heals of its own accord. Treatment where the Rectum Opens into the Vagina.—In these cases, whilethe abnormal chann(^l of comnumication may be free enough to allow the exit
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Fig. 318.—Represents a Case in which the Rectal Pouch Opens into the Vagina. may or maj not be present. Tlie Anal pouch of meconium, the further escape of the material may be prevented by an im-perforate hjrmen. This condition is readily diagnosed by the presence of abulging greenish membrane between the lips of the \ailva; and when the dis-covery is made the hymen should be incised at once. If the opening betweenthe rectum and the vagina is not sufficiently free, it should be dilated by bougiesor by a uterine dilator, or, if necessary, it should be incised. Interference shoulddepend upon the condition of the child, all radical procedures being postponeduntil, by reason of its increased age and greater strength, a favorable prognosisis warranted. Fig. 320 shows the improper method of operating in these con-ditions. At what age should the operation for a vaginal anus be undertaken? Inthe authors experience children at the age of from three to five years bear 784 AMERICAN PRACTICE OF

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