ABDOMEN, SURGERY OF. The diseases of this region are dealt with generally in the article DIGESTIVE ORGANS, and under their own names (e.g., APPENDICITIS). Under the appro priate headings the surgery of each abdominal organ is dealt with (see STOMACH, KIDNEY, LIVER, etc.) ; here the general principles of abdominal surgery are discussed.
In many cases of intra-abdom inal disease the surgeon cannot say what is wrong without making an incision and examining by sight or touch. Under conditions of strict asepsis this is not a perilous or serious procedure. When an opening is made in such circumstances—provided only it is done soon enough—the successful treatment of the case often becomes a simple matter.
A great impetus was given to the surgery of wounded, mortified, or diseased pieces of intestine by the introduction from Chicago of a contrivance named, after the inventor, Murphy's button. This consists of a short nickel-plated tube in two pieces, which are secured in the divided ends of the bowel so that when the pieces are subsequently "married" the adjusted ends of the bowel are securely fixed together and the canal rendered practicable. In the course of time the button loosens itself into the interior of the bowel and comes away with the motions. In many other types of case the button has proved convenient and successful, but sometimes ulceration occurs around the rim of the metal but ton, or the loosened metal causes trouble in its passage along the alimentary canal. Some surgeons therefore prefer a bobbin of decalcified bone or similar soft material, while others rely upon direct suturing of the parts. The last-named method has in creased in favour. The cause of death in intestinal obstruction is usually absorption of poisonous substances formed hi the bowel above the obstruction. Usually, therefore, the surgeon completes his operation for the relief of obstruction by drawing out a loop of the distended bowel, incising and evacuating it, and then care fully suturing and returning it.
Rectal or subcutaneous injections of saline or other fluid and early adoption of a sitting position for the patient are other meas ures often adopted.
The treatment of gunshot wounds of the abdomen differs according to circumstances. If the wound be caused by a rifle bullet travelling at high speed, the intra-abdominal pressure is usually sufficient to prevent escape of intestinal contents; complete rest and avoidance of surgery is the procedure of choice, and the chance of recovery is great though several coils of intestine may have been pierced. But if the wound be caused by a fragment of high explosive shell, or a revolver shot or a stab this is not the case. To avoid the onset of peritonitis, early operation, suture of the wounded gut and washing out of the peritoneal cavity afford the only chance for the patient. The "expectant" treatment which proved best in the South African War (I8gg–I 902) was at first followed in the World War, but soon was abandoned in favour of laparotomy.
This is a terribly fatal disease of infants and children, in which a piece of bowel slips into, and is gripped by, the piece next below it. Formerly attempts were made to reduce the invagination by passing air or water up the rectum under pressure, but now early recourse is had to abdominal sur gery with far better results.
With the introduction of aseptic surgery the bowel can be reached through the peritoneum easily and safely. If the cancerous mass is fairly movable the affected piece of bowel is excised, the cut ends are united and the con tinuity of the alimentary canal is re-established. When the lowest part of the bowel was found to be cancerous, the surgeon used formerly to secure an escape for the contents of the bowel by making an opening into the colon in the left loin. But in recent years this operation of lumbar colotomy has been almost entirely replaced by opening the colon in the left groin.
