EXPERIENCE indicates that 22 days ordinarily elapse from the time of exteriorization of the small bowel until the performance of the operation of complete exclusion for the control of the resulting fistula. The time will be shortened as one gains confidence in the exclusion operation, and Middleman1 has successfully reoperated as early as the fifth day after exteriorizing gangrenous ileum. To wait as long as 47 days, for instance, after exteriorizing gangrenous ileum before excluding the resulting fistula seemed to Probstein2 "what I now feel much too long a time," so that when next he had occasion, after exteriorizing jejunum, to use the exclusion operation, he waited only 14 days. The urgent need for hastening the exclusion operation for the control of jejunal or ileal fistulas is therefore the topic of this presentation.
How long a patient may be expected to survive exteriorization of gangrenous small bowel without