Identifier: operativesurgery02brya (find matches)
Title: Operative surgery
Year: 1899 (1890s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914
Subjects: Surgery, Operative Surgery, Operative
Publisher: New York : D. Appleton and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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roughthe fascia without cutting; sever the transverse muscular fiber layer thatconnects the anterior bundles of the levator ani muscle at the anterior sur-face of the rectum; separate and draw aside the fibers of the levator ani soas to bring into view the posterior surface of the prostate and the seminalvesicles higher up (Fig. 1332); open through the sheath of the prostate intothe abscess cavity carefully; evacuate, wash out the abscess, and drain with 1146 OPERATIVE SURGERY. a small tube or gauze wick; close the external wound with silkworm gut,except at the center of the perinteum, which is left open for drainage pur-poses. The abscess can be opened satisfactorily in thin subjects by a medianperineal incision made behind the urethra into the sheath of the prostate. After the detection of pus by the needle or by palpation, introduce theleft forefinger into the rectum and locate the fluctuating point; failing inthis, place the end of the finger at the apex of the prostate. Introduce
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Fiu. 1332.—Deep siirgieiil anatomy of perinaHiin. a. Levator ani inusele. b. Internalpudic nerve, c. Internal pudic artery, d. Transversus perinei muscle, e. Fibers ofcompressor uretliral muscle. /. Prostate body. g. Yas deferens. //. Yesicula semi-nalis. L Rectum, j. Bladder. (without removing the finger) with the cutting edge upward, a long, straight,narrow bistoury at the median line of the perinaeum, three quarters of aninch in front of the anus, and thrust it upward to the abscess, guided bythe fingers in the rectum; enlarge the incision upward sufficiently, on with-drawal of the knife, to afford free exit for pus; explore the cavity with anaseptic finger, breaking down abscess partitions when found ; irrigate thewound with a hot saline solution, and arrest profuse deep ha3morrhage bypacking. OPERATIONS OX TlllO Li:L\Ai:V liLADDEli. 1 (4.7 111 eitluT iiistimce tlic tube sliould bo roinoved ufter a few days and gauzedrainage only employed, allowing union by granulation. Ihe liii

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