Identifier: diseasesofkidney01kell (find matches)
Title: Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women
Year: 1922 (1920s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943 Brödel, Max, 1870-1941 Burnam, Curtis Field, 1877-
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Publisher: New York, London : D. Appleton and company

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Ample exposure is necessary in such a case owing to the intimateattachment between the capsule of the kidney and the peritoneum. In separating thesestructures, the colon and, on the right side, the duodenum may be injured. typical McBurney operation for appendicitis. The external oblique fibers arelongest and should be separated in the lines between the anterior-superior spineof the ilium and the tip of the last rib. When separated the internal obliquecomes into view (Fig. 184). Its fibers are longest and should be divided ina line from the 9th costal cartilage to the middle of the crest of the ilium. Twopoints on this line permit perforation of the muscles without injury to eithernerves or vessels. One is just above the subcostal nerve and vessels, the otherbelow them. It is well to remember that the vessels and nerves run beneaththe muscles. The relations are shown in Figure 185. The separation of thefibers of the internal oblique exposes those of the transversalis, which are sepa-
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Fig. 189.—T-Shaped Incision. This gives abundance of room and is suitable wlien alarge tumor of the kidney is to be dealt with. The perpendicular arm follows the linearsemilunaris; the transverse is approximately parallel to the last rib. The incisionsare carried through all the layers of the abdomen down to the peritoneum. 401 402 SURGICAL OPERATIONS ON THE KIDNEY. rated, as shown in Figure 186. The fibers of the transversalis are of aboutequal length in all parts of the muscles. The relation of the vessels and nervesto this incision are shown in Figures 192 and 193. At the upper and outer ^..^ Subcostal (xn.) \^-^ y- Latera-l cutkns

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