Chapter 5 THE PANCREAS 863
ANATOMY 863
EMBRYOLOGY AND HISTOLOGY 871
PHYSIOLOGY 872
GENERAL SURGICAL CONSIDERATIONS 874
METHODS OF EXPOSING THE PANCREAS 875
CONGENITAL MALFORMATIONS OF THE PANCREAS 879
Pancreas Divisum 879
Ectopic or Aberrant Pancreas 879
Annular Pancreas 881
Fibrocystic Pancreas 883
PANCREATIC INJURIES 883
Operative Treatment for penetrating and Nonpenetrating pancreatic Injuries 887
Treatment of Operative Injuries of the Pancreas 889
Incision for Biopsy 889
Injury to the Tail and Body of the pancreas 889
Injury to the Head of the Pancreas 890
PANCREATITIS 892
Acute Pancreatitis 892
Nonsurgical Treatment 896
Operative Treatment by Pancreatotomy and Drainage by the Transgastrocolic Route 899
Chronic Pancreatitis 900
Choledochal Sphincterotomy 902
Dilation of the Sphincter of Oddi 903
Choledochojejunostomy (Bowers) 904
Other Sidetracking Operations 905
Decompression procedures 905
Pancreatolithotomy 905
Sympathectomy 907
Ligation of Pancreatic Duct 916
Interlocking Mattress Ligation of Pancreas 916
Other Operations for Pancreatitis and Pancreatic Lithiasis 917
Results of Surgical Treatment of Chronic Relapsing Pancreatitis 917
CYSTS OF THE PANCREAS AND THEIR EXTENSIONS 918
Marsupialization of Pancreatic Cyst 920
Excision of a Pancreatic Cyst 922
Internal Drainage of Pancreatic Cysts 923
Roux-en-Y Cystojejunostomy 924
Partial Pancreatectomy Including Cyst in Resection 925
PANCREATIC FISTULAS 925
Excision of Pancreatic Fistula 926
Internal Drainage of Pancreatic Fistula 927
Excision of Tract Combined with Partial Pancreatectomy 927
Excision of Tract Combined with Sphincterotomy 928
ISLEI CELL TUMORS OF THE PANCREAS 928
Excision of Islet Cell Tumor of Pancreas 930
PAPTIAL PANCREATECTOMY:EXCISION OF THE TALL AND BODY OF THE PANCREAS 934
CARCINOMA OF THE PANCREAS 938
CARINOMA OF THE AMPULLA OF VATER 939
PANCREATODUODENAL RESECTION 940
One-Stage Pancreatoduodenal Resection (Trimble) 943
Two-Stage Partial or Total Pancreatoduodenal Resection (Whipple) 959
Two-Stage Partial or Total Pancreatoduodenal Resection (Cattell) 961
Complication s Following Pancreatoduodenal Resection 962
Results of Pancreatoduodenal Resection 964
PALLIATIVE OPERATIONS FOR INOPERABLE CARCINOMA OF PANCREAS 964
REFERENCES 966
Chapter 6 THE SPLEEN 969
ANATOMY 969
PHYSIOLOGY 970
ACCESSORY SPLEENS 970
SPLENOSIS 972
GENERAL SURGICAL CONSIDERATIONS 972
INCISIONS 973
EXPLORATORY PUNCTURE OF THE SPLEEN AND SPLENIC BIOPSY 973
TOTAL SPLENECTOMY 975
LIGATION OF SPLENIC ARTERY 990
PARTIAL SPLENECTOMY 990
SPLENOTOMY 991
SURGICAL TREATMENT OF WOUNDS OF THE SPLEEN 992
Abdominal Wounds of the Spleen 992
Transthoracic Wounds of the Spleen 995
SPLENOPEXY FOR SPLENOPTOSIS 996
POSTOPERATIVE CARE IN OPOERATION UPON THE SPLEEN 996
REFERENCES 997
Chapter 7 THE SMALL INTESTINE (JEJUNAL AND ILEAL PORTIONS) 999
ANATOMY 999
PHYSIOLOGY 1005
CONGENITAL ABNORMALITIES OF THE SMALL INTESTINE 1011
DISEASES OF THE JEJUNOILEUM 1017
Diverticulosis 1017
Tumors 1019
Primary Ulcer of the Jejunoileum 1024
Primary Jejunal Ulcer 1024
Primary Ileal Ulcer 1025
GENERAL SURGICAL CONSIDERATIONS IN OPERATING UPON THE INTESTINES 1026
ENTEROTOMY 1032
REPAIR OF INTESTINAL WOUNDS AND PERFORATIONS 1034
Repair of Wounds Due to Trauma 1035
Repair of Ulcerative Perforations 1039
ENTEROSTOMY 1040
Jejunostomy 1041
Temporary Jejunostomy 1043
Permanent Jejunostomy 1047
Jejunostomy Feeding 1049
Ileostomy 1051
Ileostomy with a Tube 1054
Ileostomy without a Tube:Tangential Ileostomy 1057
Ileostomy without a Tube:Double-Barrelled Ileostomy 1059
Ileostomy without a Tube:Double-Barrelled Ileostomy with Separation of the Stomas 1060
Ileostomy without a Tube:Stone Method 1062
Ileostomy without a Tube:Single-Barrelled Method 1066
Complications after Ileostomy 1072
Skin Grafting of Ileostomy Opening 1075
Closure of Enterostomy Stomas 1076
Closure of a Maydl Jejunostomy Stoma 1076
Closure of a Tangential,Loop or Double-Barrelled Ileostomy Stoma 1077
Closure of a Single-Barrelled Ileostomy Stoma 1079
Closure by the Intraperitoneal Route 1079
Summary of Enterostomy and Its Closure 1080
CLOSURE OF FISTULAS OF SMALL INTESTINE 1080
Closure of External Fistula 1080
Closure of Internal Intestinal Fistula 1089
Postoperative Care in Closure of Fecal Fistula 1091
Comments on Closure of Fecal Fistula 1092
PARTIAL ENTERECTOMY 1092
ANASTOMOSIS OF THE INTESTINE 1098
Lateral (Side-to-Side) Anastomosis after Enterectomy 1099
End-to-End Anastomosis 1107
End-to-Side Anastomosis 1132
Closed Side-to-Side Anastomosis 1135
Comparison of Intestinal Anastomosis 1135
OPERATIONS FOR SHORT-CIRCUITING (EXCLUSION,BY-PASSING) A SEGNENT OF INTESTINE 1137
Partial Short-Circuiting of a Segment of Small Intestine by Lateral Anastomosis between Its Limbs 1137
Partial Exclusion of a Loop of Bowel 1139
Complete (Bilateral) Exclusion of a Segment of Intestine 1139
INTESTINAL OBSTRUCTION 1140
Paralytic Ileus 1143
Dynamic (Spastic) Ileus 1145
Mechanical Intestinal Obstruction 1146
Intestinal Obstruction from Adhesions 1160
Plication of the Small Intestine for Adhesions (Noble) 1163
Immediate Postoperative Obstruction 1168
Intestinal Obstruction from External Hernia 1172
Intestinal Obstruction from Internal Hernia 1173
Obstruction of the Small Intestine by Foreign Bodies 1173
Volvulus of the Small Intestine (Not Due to Malrotation) 1173
Other Types of Mechanical Obstruction 1176
Intestinal Obstruction Due to Mesenteric Vascular Occlusion 1176
MALROTATION OF THE INTESTINE 1181
First Stage of Midgut Rotation 1181
Second Stage of Midgut Rotation 1182
Third Stage of Midgut Rotation 1186
Omphalocele Resulting form Failure of Rotation beyond the First Stage 1186
One-Stage Operation 1188
Two-Stage Operation (Gross) 1191
Nonrotation Resulting from Failure in Second Stage 1199
Operation for Duodenal Obstruction Caused by Nonrotation of the Midgut (Ladd) 1200
Congenital Volvulus of Midgut Resulting from Abnormality of Second Stage 1200
Malrotation during Second Stage of Midgut Rotation 1207
Internal Hernia Resulting from Abnormality of Second Stage 1209
Reversed Rotation 1214
Subhepatic Cecum 1215
Retrocecal Appendix 1217
Mobile Cecum 1217
CONGENITAL ATRESIA 1218
CONGENITAL STENOSIS OF THE INTESTINE AND COLON 1232
MECONIUM ILEUS 1239
Surgical Lavage of Intestine through a Tube 1241
Resection of Obstructed Segment of Ileum with End-to-End Anastomosis 1242
Witzel Enterostomy 1242
Mikulicz Resection with Ileocolostomy 1242
Mikulicz Resection and Double Ileostomy 1243
Results of Surgical Treatment by the Various Methods 1244
Convalescent Care Following Surgical Treatment 1245
DUPLICATIONS OF THE ALIMENTARY TRACT 1246
Surgical Treatments 1253
Duplications Arising in the Thorax 1253
Duplications in the Thorax Arising from Intestine 1254
Duplications of the Stomach 1255
Duplications of the Duodenum 1255
Duplication of the Intestine 1256
Duplications of the Colon and Rectum 1256
Results of Surgical Treatment 1259
MESETERIC CYSTS 1259
MULTIPLE CYSTIC DISEASE OF THE MESENTERY 1262
OMENTAL CYSTS 1262
MECKEL＇S DIVERTICULUM 1263
INTUSSUSCEPTION IN INFANTS AND CHILDREN 1271
Surgical Treatment 1275
Reducible Intussusception 1276
Irreducible or Gangrenous Intussusception 1280
Recurring Intussusception 1290
Results of Surgical Treatment 1291
Nonsurgical Treatment 1291
INTUSSUSCEPTION IN OLDER CHILDREN AND ADULTS 1295
REGIONAL ENTERITIS (CROHN＇S DISEASE) 1297
Surgical Treatment 1306
Ileotransverse Colostomy with Transection of the Ileum 1307
One-Stage Resection 1308
Two-Stage Resections 1309
Comments on Surgical Treatment 1310
Recurrences 1312
REFERENCES 1314
Chapter 8 THE PERITONEUM,OMENTA AND MESENTERY 1319
ANATOMY 1319
OPERATIONS UPON THE PERITONEUM 1321
Surgical Treatment of Peritonitis 1321
Localized Peritonitis 1321
Diffuse Suppurative Peritonitis 1323
Prevention of Diffuse Peritonitis in Abdominal Injuries*1327+++Operations for Torsion(Volvulus)of the Omentum 1329
OPERATIONS ON THE GREAT OMENTUM 1328
Omental Grafting 1328
Partial or Complete Excision of the Great Omentum 1329
Operations for Torsion(Volvulus)of the Omentum 1329
Omentopexy for Cirrhosis of the Liver 1330
Removal of Cysts of the Omentum 1330
OPERATIONS UPON THE MESENTERY 1331
REFERENCES 1331
Chapter 9 THE COLON 1333
ANATOMY 1333
PHYSIOLOGY 1349
DEVELOPMENTAL ANOMALIES OF THE COLON 1352
DISEASES OF THE APPENDIX 1352
Appendicitis 1352
Acute Appendicitis 1353
Chronic and Chronically Recurring Appendicitis 1359
Appendiceal Abscess 1359
Other Lesions of the Appendix 1360
OPERATIONS UPON THE APPENDIX 1361
Appendectomy 1361
Drainage of Appendiceal Abscess 1371
Drainage of Pelvic Abscess 1373
Appendicostomy 1374
INJURIES OF THE COLON 1376
Surgical Treatment 1378
FOREIGN BODIES 1385
FECAL IMPACTION 1386
TUMORS OF THE COLON 1387
Benign Tumors 1387
Polyps or Multiple Polyps of the Colon 1388
Diffuse Familial (Multiple) Polyposis of the Colon 1393
Endometrioma (Adenomyoma) 1398
Other Benign Tumors of the Colon 1403
Malignant Tumors 1404
DIVERTICULA OF THE COLON 1416
DIVERTICULA OF CECUM 1434
PERSISTENT COLONIC FISTULAS 1435
Internal Persistent Colonic Fistula 1435
External Persistent Fecal Fistula 1436
NONSPECIFIC (IDIOPATHIC) ULCERATIVE COLITIS 1439
Pelvic Autonomic Neurectomy for Ulcerative Colitis 1461
CONGENITAL MEGACOLON (HIRSCHSPRUNG＇S DISEASE) 1462
Surgical Treatment 1469
One-Stage Abdominoperineal Resection of Rectosigmoid (Swenson) 1470
Colostomy for Congenital Megacolon 1477
Partial Colectomy for Congenital Megacolon 1480
Lumbar Sympathectomy 1480
Paravertebral Sympathetic Block 1487
VOLVULUS OF THE SIGMOID 1489
VOLVULUS OF THE CECUM 1497
Operation for Volvulus of Cecum 1498
GENERAL CONSIDERATIONS IN OPERATIONS UPON THE COLON 1498
COLOTOMY 1500
COLOPEXY 1502
COLOSTOMY 1503
Temporary Tube Colostomies 1507
Tangential Colostomy 1509
Double-Barrelled Colostomies 1512
Loop Colostomy 1512
Spur Colostomy 1521
Terminal Single-Barrelled Colostomy 1530
Complications after Colostomy 1533
Comments on Colostomy 1538
Care of Bowel and Stoma Following Permanent Colostomy 1540
Intraperitoneal Closure of a Colostomy Stoma 1542
OPERATIONS FOR SHORT-CIRCUITING THE COLON 1545
RESECTION OF THE COLON 1549
Resection of the Right Colon 1551
One-Stage Resection of Right Colon 1553
Two-Stage Resection of Right Colon 1562
Three-Stage Resection of Right Colon 1565
Mikulicz Exteriorization Resection (Lahey Modification) 1566
Comments on Resection of Right Colon 1569
Resection of the Transverse Colon 1570
One-Stage Resection with Primary Anastomosis 1570
Multiple-Stage Resection of Transverse Colon 1577
Obstructive Resection of Transverse Colon (Rankin) 1578
Resection of the Descending Colon and Sigmoid 1581
One-Stage Resection with Primary End-to-End Anastomosis 1581
Three-Stage Resection of Sigmoid (Schloffer) 1585
Mikulicz-Paul Resection of Sigmoid 1585
Other Methods 1587
Resection of Short Segment of Colon 1588
Colectomy 1589
One-Stage Colectomy with Ileostomy 1590
One-Stage Subtotal Colectomy with Ileorectotomy 1593
One-Stage Subtotal Colectomy with Ileostomy 1596
Total Colectomy with Anal Ileostomy and Preservation of Anal Sphincter (Ravitch) 1596
Two-Stage Total Colectomy with Permanent Ileostomy 1610
Two-Stage Subtotal Colectomy 1615
Three-Stage Total Colectomy with Ileostomy 1617
Four-Stage Total Colectomy 1622
Comments on Segmental,Partial,Subtotal and Total Colectomy 1625
REFERENCES 1629