Plate 47
###### Figure 16

This resection is usually an emergency procedure utilized in the presence of sudden obstruction, such as gangrenous intestine in a strangulated hernia, or from volvulus. Less frequently, it is used in mesenteric thrombosis and obstruction by tumor. Since the end-to-end anastomosis restores more accurately the natural continuity of the bowel, it is usually preferable to a lateral anastomosis; however, the surgeon should be familiar with the side-to-side anastomosis, which is favored when there is marked disparity between the sizes of the ends of bowel to be anastomosed.

Since resection and anastomosis of the small intestine usually constitutes an emergency procedure, preoperative measures are necessarily limited. However, before operation is attempted, the stomach is emptied and constant gastric suction maintained. Fluid and electrolyte balance, including normal sodium, chloride, and potassium levels, should be established in accordance with the degree of fluid depletion and the age and cardiac status of the patient. Colloid solutions are indicated if the obstruction is marked, the pulse elevated, or gangrenous intestine suspected. Antibiotic therapy should be instituted if gangrenous intestine is suspected. The pulse should be slowed and a good output of urine established as evidence of adequate blood volume expansion before surgery. Constant bladder drainage may be necessary to determine accurately ...

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