The ileum is
then severed from the mesentery as follows: The intestine is pulled
by the left hand straight down in the middle line of the right thigh,
putting the mesentery on a stretch. The long section-knife is used
by the right hand to cut the mesentery close to the intestine in a
manner resembling the use of the bow in violin-playing. The blade
of the knife is held slightly obliquely against the mesenteric
insertion of the intestine, and as the left hand pulls up the coils
of intestine against the knife, the latter in the bowing or sawing
movement severs the mesentery from the intestine as close to its
insertion as is possible without cutting the intestine. The freed
portions of intestine are caught in the tray resting on the thighs,
and the left hand grasps in succession new portions of the small
intestine and pulls them against the knife until the entire intestine
is freed up to the duodenum and the root of the mesentery. A double
ligature is put around the jejunum and the intestine severed between
the ligatures, and the freed jejunum, ileum and large intestine
are now removed in the tray for examination. The severing of the
intestine from the mesentery in this manner can be carried out very
quickly after a little practice. Care must be taken to cut the
mesentery as close as possible to the intestine without nicking the
latter. If too much mesentery is left on the intestine it cannot be
laid out straight and its opening is made more difficult. If the
coils of the small intestine are left in their natural position,
and if the ileum when it is first taken up by the left hand is
not twisted, the coils will unroll before the knife without any
difficulty. Some prosectors begin with the jejunum, ligating it at
the point where it comes out from beneath the mesentery, cutting it
between the ligatures and separating it from the mesentery downward
until the entire intestine as far as the rectum has been freed. The
latter is ligatured and the freed portions removed. When the saving
of time is of great importance the large intestine may be freed as
described above, a ligature put around the upper end of the jejunum,
and the mesentery severed at its root, so that the entire mass of
small intestine with its mesentery is removed for further separation
from the mesentery outside of the body. When peritoneal adhesions
that cannot be easily torn are present it may be necessary to remove
the intestines with mesentery attached.
Public-domain text, read in full here on John Shaqi.
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