(see ABDOMEN, SURGERY OF).—In the case of the stomach and duodenum—the diagnosis of simple ulcers and cancerous growths of the stomach has been greatly advanced by radiological methods. The method does not consist in simply taking a shadow picture of the stomach. Chief reliance is placed on observation of the stomach movements by a trained observer. It must not however be thought that this is the only or the final method of diagnosis. Clinical observation and the chemical examination of test meals are essential and often carry equal weight in forming an opinion as to the exact condition.
Operation is much less frequently undertaken for active gastric and duodenal ulcer (q.v.) now than a few years back. It still remains the only radical method of dealing with long-standing ulcers which have led to adhesions of the stomach and surround ing structures or to narrowing of its lumen either in the body of the organ or at its junction with the duodenum. The simplest operation is that of gastro-enterostomy, which consists of short circuiting the distal part of the stomach and duodenum by anastomosing a loop of adjacent small bowel direct to the stomach. A part of the stomach may be removed for chronic ulcer as it is for cancer; indeed very nearly the whole stomach has been successfully removed for this condition, an anastomosis being subsequently established between the cut upper end and the small bowel. Surgery offers the only satisfactory means known at the present to deal with cancer of the stomach.
The gall bladder forms a reservoir for bile though it has nothing to do with the secretion of this fluid. Gall stones (see CALCULI) may be deposited in it and lead to attacks of acute pain if they are forced out of the gall bladder into the bile passages. The presence of stones may also irritate the bladder and lead to abscess formation. The diagnosis is usually made clinically although the shadow of the gall bladder outline can be obtained by injecting a chemical into the blood, and in some instances gall stones show up in radiographs. The operation at the present time most often performed is complete removal of the gall bladder including the stones.
Considerable sections of the large bowel can be removed for growths which are usually malignant. Sections of the bowel may also be cut out on account of inflammatory con ditions. After resection of part of the bowel the lumen is recon stituted by an anastomosis. This may be effected by stitching the two cut ends of the tube together directly, or by laying them side to side and making a lateral communication after stitching up the ends. Cases of intestinal obstruction due to irremovable
causes in the lower part of the bowel are treated by colostomy. This operation consists in bringing up to the surface a section of the bowel and opening it. The artificial anus so formed will drain the bowel effectively, but the condition has the inconveni ence that it is not subject to any sphincter control.
The rectum is subject to similar growths and inflammatory conditions to those met with in the colon. If a cancer of the rectum is recognized early, its radical removal gives a very good proportion of cures. It is inevitable in all such cases for the sphincter mechanism of the bowel to be destroyed by the operation and the patient is therefore left with a colostomy. An anal fistula (see FISTULA) consists of a communication be tween the lower part of the rectum and the surface. It usually follows the formation of spontaneous evacuation of an abscess in this area. The condition can only be effectively cured by laying open the whole fistulous tract, and leaving it to heal slowly by granulation.
(q.v.) are due to a varicose condition of the veins in the lower part of the rectum. They may cause pro lapse of the mucous lining of the lower end of the rectum or they may become grossly inflamed and painful. Slight damage to them may lead to troublesome haemorrhage. The condition is usually quite a local one and can be dealt with successfully by several means. Injection of the piles with chemical solution will produce clotting or scarring of the vascular area sufficient to cure the slighter cases of internal haemorrhoids. More severe persistent cases are better dealt with by operations of excision and ligature. Kidneys and Bladder. (See UROLOGY; BLADDER AND PROS TATE DISEASES.)—The accurate diagnosis of the diseases of the kidney and bladder have made great advances in the last ten years as the result of the perfection of instruments for inspecting the inside of the bladder and passing catheters up the ureters. The injection of opaque solutions into the cavity of the kidneys en ables a radiograph to be taken which assists considerably in diag nosis. Better radiological technique has also increased the accu racy with which the presence of a stone and its position in the kidney can be made out. The estimation of the functional activ ity of the kidney by mechanical means has been put on a scientific basis and makes it possible for the surgeon to assess the patient's probable reaction to operations in this area.