For the ordinary autopsy the following order of examination of the
abdominal organs is recommended: The spleen is first examined. It
is lifted up from beneath the left under-surface of the diaphragm
by tearing or stretching the ligamentum phrenico-lienale and the
gastrosplenic omentum. In the case of wandering spleen the technique
of removal must be modified to suit the conditions. When the spleen
is very soft great care must be taken not to tear or rupture it.
When adhesions to the diaphragm are present these must be torn or
cut. The spleen is then laid upon the left edge of the ribs. In this
position it may be sectioned by an incision made from upper to lower
pole, and then, after it has been examined, it is allowed to slip
back into the abdominal cavity, when its removal from the body is not
desired. If it is to be removed and examined outside of the body,
its ligaments and vessels are cut with the knife directed against
the edge of the ribs, taking care not to cut the stomach or tail of
the pancreas. It is then weighed and measured, and examined by means
of a chief incision through its convex surface, from upper to lower
pole, and reaching to the hilus. Parallel sagittal or transverse cuts
may be made as desired. The cut surface is then thoroughly examined.
Bacteriologic examinations should be made when indicated, before
the organ is sectioned. A portion of the capsule is seared and the
pipette introduced through the seared area.
The =intestines= are examined next. They may be opened inside the
body without separating them from the mesentery, but the best method
by far is to remove and open them outside of the body. The middle
portion of the transverse colon is lifted up by the left hand and
the ligamentum gastrocolicum and the mesocolon transversum cut close
to the intestine, toward the left, separating the left half of the
transverse colon, then the splenic flexure and the descending colon
and the sigmoid flexure to the rectum. After the splenic flexure has
been separated the descending colon can usually be stripped down to
the sigmoid by the hands without using the knife. When the sigmoid
has been freed from its mesocolon two ligatures are put around the
upper portion of the rectum, about an inch apart, and the intestine
is then cut between the ligatures. The freed portion of the large
intestine is then carried over into the right side of the abdomen
and as much of the lower portion as is possible is put into a pan or
tray resting upon the cadaver’s right thigh. The right half of the
transverse colon, the hepatic flexure and the ascending colon are
now freed down to the beginning of the ileum, care being taken not
to cut off the appendix when loosening the cæcum. The entire large
intestine is then gathered into the tray resting on the cadaver’s
thighs, and the intestine is pulled down firmly by the left hand in
a line corresponding to the main axis of the right thigh. The coils
of small intestine are left in their natural position.
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