A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
=Indications for Drainage.=--Great diversity of practice exists among
operators as to the use of drainage after celiotomy, and a decided
change has taken place in regard to drainage during the past twenty
years. In the early days of modern abdominal surgery drainage was used
very much more than it is at present; some of the best operators used
it in the majority of their cases; now a number of operators never
use drainage after celiotomy, while others use it only when specially
indicated. Much depends upon the individual methods of the operator.
The operator who is careless in his asepsis and hemostasis should
use drainage oftener than he who is careful in these particulars. The
advice, “When in doubt drain,” is very good; but the surgeon should
strive to eliminate the element of doubt as much as possible, and to
have a definite reason for all his procedures. If drainage is not
necessary, it is harmful. It necessitates more frequent dressings and
disturbance of the patient, and it prevents perfect closure of the
abdominal incision.
The object of drainage is the removal from the peritoneum of discharges
which are, or which may become, septic or dangerous. Such discharges
are blood, pus, serum, cyst-contents, and ascitic fluid.
Even though the peritoneum be dry and all bleeding be arrested when the
operation is completed, yet it must be remembered that a subsequent
free serous exudation will take place if the peritoneum has been
exposed or subjected to chemical or mechanical irritation.
Infection may take place from imperfect asepsis at the time of
operation; or it may be caused by the escape into the peritoneum of
septic material which existed in the abdomen before the operation; or
it may occur subsequently, from the passage of septic organisms from
the interior of the intestine through the intestinal wall.
The absorbing power of the healthy peritoneum is so great that a large
amount of fluid (even though not absolutely sterile) may be taken up by
it. Injury of the peritoneum from exposure or other irritation not only
increases the amount of fluid to be absorbed, but it diminishes the
power of absorption; and injury of the intestinal peritoneum or of the
wall of the intestine favors the passage of septic organisms through it.
The operator should bear these facts in mind when he considers the
subject of drainage.
A certain amount of absorption of blood or other sterile fluid may be
trusted to the peritoneum.
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