A CASE OF DISEASE OF THE HIP-JOINT DUE TO STREPTOCOCCAL INVASION, WITH SECONDARY MANIFESTATIONS IN OTHER PARTS
1108 a weak spot. Bishop records a case where he first did a colostomy, but the advantage of such a preliminary step in preference to treating the whole condition through a coeliotomy wound is not very apparent. I Oderfeld's operation,2 with immediate resection, is the best yet suggested when the conditions of the patient and of the bowel are satisfactory, but as in simple resection any paralysis of the bowels would tend to a rupture at the suture line, the intussusceptum should always be
... uld always be removed per anum at the time of the operation, and the lower bowel irrigated with warm sterile salt solution. The usual method of closing a colostomy wound by excision is not very satisfactory, inasmuch as the surrounding skin cannot be rendered sterile and a general peritonitis cannot with certainty be avoided. With thin and lax abdominal walls the method here adopted is not difficult, and the colostomy wound -could be excised after the pieces of bowel have been evaginated if preferred. This would open up the peritoneal cavity, but there would be no manipulation of its contents through the opening. The external ligature round the bowel approximates serous to serous coats, and could be done with more safety if the peritoneum were fixed . to the skin at the first operation. A second closing might be necessary to prevent hernia, but the whole aim of the surgeon should be the safety of the patient and not the brilliancy of the operation. Dundee.