Remarks on diaphragmatic herniae / by Arthur Keith.

  • Arthur Keith
Date:
1910
Catalogue details

Licence: In copyright

Credit: Remarks on diaphragmatic herniae / by Arthur Keith. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    these cases was congenital hernia of the pleuro peritoneal passage. From an examination of the present series of cases I am of opinion that a considerable number of these cases might be successfully operated on if the condition were recognized at the time of birth. II.—Hernia through the Oesophageal Orifice of the Diaphragm. As may be seen from Fig. 1, there was only one specimen in the series of 34 which showed a hernia at the oeso- phageal orifice. This specimen is in the museum of Guy’s Hospital, and shows the greater part of the stomach in the right pleural cavity. Mr Lawford Koaggs has described several cases; Mr. W. A. E Waller has recently placed a remarkable one on record in a young man of 19; Dr. Barclay Smith found the condition associated with great dilatation of the sigmoid colon. Mr. Rigby and the writer have recorded a case in which a partial hernia of the stomach through the oesophageal orifice was associated with enteroptosis. Ill —Herniae through the Right Leaflet of the Diaphragm. As shown in Fig. 1, there were only two cases of hernia through the right leaflet—one in a child of 4 months, where a process of the liver, about the size of a cricket ball, occu- pied a sac formed from the expanded central tendon ; and another, also in a child, where a process of the liver lay free in the floor of the right pleural cavity. There can be little doubt that both of these were congenital in origin and were produced by an abnormal development of the liver within the septum transversum of the embryo. Pro- fessor Arthur Thomson has recorded a similar occurrence in the rabbit, the abnormal process of liver resembling an accessory heart. 1Y —Hernia into the Pericardium. There were three cases of hernia into the pericardium through a perforation of the central tendon of tbe diaphragm. In the case of a man of 50 a process of omentum occupied the orifice; in a man of 47 a process of liver formed the extruded part. In neither of these cases was there a hernial sac, but in the third case, in a child at birth, the process of liver was enclosed in a sac formed by the central tendon. It is possible that the two cases in adults were the result of a former injury. Elder and Postlethwaite report a case where the lobe of a malformed liver occupied a diverticulum of the right central tendon, the diverticulum reaching the level of the second rib. Y.—Hernia through the Left Dome of the Diaphragm. Herniae through the left pleuro-peritoneal passage are four times more common than through tbe right, and the same statement holds true as regards the various forms of hernia which occur at the domes and sterno costal
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