Identifier: manualofoperativ0001trev (find matches)
Title: A manual of operative surgery
Year: 1910 (1910s)
Authors: Treves, Frederick, Sir, 1853-1923 Hutchinson, Jonathan, 1859-1933
Subjects: Surgical Procedures, Operative Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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elvis against the abdominal wall whenonly moderately distended. Fig. 145 shows the effect of strong distension of the bladderin an adult. The bladder assumes a spherical form, the pros-tatic urethra becomes nearly horizontal, and the prevesicalfold of peritoneum is raised 2 cm. above the symphysis pubis.It may be noted that in another case less forcible distensionmight raise the reflexion of the peritoneum more than in theexperiment quoted. It is not safe to employ forcible injectionof fluid, since this has led in some cases to rupture of the bladder.In the case of a child, about four to six ounces, in an adultfrom ten to twelve, may be taken as an average amount to CHAP. XX) SUPRAPUBIC LITHOTOMY 575 employ. The bladder should be slowly filled, and the surgeonshould estimate the distension by his hand placed above thepubes. Preparation of the Patient.—If the bladder be undulyirritable, it is recommended that it be washed out dailyfor some few days beforehand. The rectum must be well
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FIG. I4S.—EFFECTS OF DISTENSION OF THE BLADDER UPON ITS POSITION. a, Anterior, and b, Posterior, reflexion of peritoneum. (Fehleisen.) emptied. In the adult the pubic region should be shaved.In any case, the skin is made as sterile as possible. By means of the X-rays it is easy to have determined theexact size of the stone before operation. If more than onecalculus be present the radiograph will have shown this to bethe case. The patient lies upon the back, close to the right edge ofthe table. The pelvis should be so raised that the intestines 576 ABDOMINAL OPERATIONS (part n fall away from the bladder. A few pads are wedged inagainst the perineum, to collect any blood or fluid which mayrun in that direction, and packing towels are placed under eachloin. The surgeon stands to the patients right, and the chiefassistant takes his place upon the opposite side of the table. Instruments Required.—A scalpel; probe-pointed bistoury ;scissors ; sharp hook, blunt hooks ; dissecting, artery

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