CELSUS

be the case, the fistula is safer opposite the liver, the spleen, and the stomach than it is opposite the intestines, not because it is more deadly in that location, but because it creates room for a different danger. Moved by the experience of this, certain authors have understood little of the nature of the matter. For the belly is often even pierced by a weapon, and the protruded intestines are returned, and sutures grasp the edges of the wound; B I will soon indicate how this is done. Therefore, even where a thin fistula breaks through the abdomen, it is permitted to cut it out and join the edges with a suture. If, however, that fistula has opened internally, once excised, it must necessarily leave a wider opening, which cannot be closed except with great force, especially from the inner side; for a certain membrane lines the abdomen, which the Greeks call the peritonaeon peritoneum. Therefore, when someone begins to walk and move about, that suture is ruptured, and the intestines are released; from which it happens that the person must perish. But the situation is not in every way hopeless, and therefore treatment should be applied to thinner fistulae.

4 Those that are in the anus require even more specific consideration. Into these, once a probe has been sent down to its final end, the skin ought to be cut, then the probe is to be led out through the new opening with a linen thread following it, which has been cast through the other part of it, which was perforated for that very reason. There, the thread must be taken and bound to the other end, so that it may hold loosely the skin which is over the fistula; and that thread must be raw and double or triple, twisted so that a single unit is made.

a Prolapse of the intestines, described below.
b VII. 16. 4.
c IV. 1. 13.
d VI. 18. 7.