Remarks on the modes of proceeding in regard to the hernial sac in th operation for strangulated hernia / by William Pirrie.

  • William Pirrie
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the modes of proceeding in regard to the hernial sac in th operation for strangulated hernia / by William Pirrie. Source: Wellcome Collection.

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    the abdomen, will now retain it in the sac; and as, through the me¬ dium of these portions, the hernial sac and serous coat of the intes¬ tine, which forms the hernia, are continuous with each other, it is evident that reduction must be impracticable. It is as impracticable under these circumstances to return the intestine, as it would be to return the testicle into the abdomen ; the intestine draws the peri¬ toneum along with it to form hernial sac, and the testicle draws peritoneum to form tunica vaginalis; and the serous coat of the in¬ testine has the same relation to the hernial sac as the tunica vagi¬ nalis propria has to the tunica vaginalis reflexa. Such a hernia, when it becomes strangulated, and the subject of operation, re¬ quires a particular method of treatment, which will afterwards be explained. Adhesions of the protruded parts to each other, often form the impediment to reduction. The parts which form a hernia often glide down separately and to a great extent into the sac; and afterwards, by pressure and various accidental causes, adhere to each other, and cannot in mass be returned through the opening by which they separately left the abdomen. A frequent impediment to reduction is the bulk of the protruded parts in relation to the opening through which they would have to be returned. The bulk is sometimes owing to the quantity of parts which have come out from the abdomen, especially in neglected cases, where means have not been used to give a degree of support. Another more frequent cause is the enlargement or growth of some parts constituting the hernia. The omentum and mesentery are the parts which, when protruded, present the impediment to reduction from growth, and their increase is occasioned mostly by deposition of fat in the portions of these tissues external to the opening through which they came out from the abdomen. Where they are embraced by the opening, the pressure prevents enlargement in that situation; but from the yielding nature of textures external to the opening, the increase of volume is often very considerable. In old liernise, which have been long irreducible, this condition is sometimes met with to a great extent. Such are the principal conditions which, indepen¬ dent of the stricture, offer an obstacle to the reduction of a hernia. If any of these conditions exist, and if the sac be not opened, re¬ duction is in general impracticable. If the sac be opened, two of them may easily be overcome; namely, the soft recent adhesions formed by coagulable lymph and the filamentous,—the former can be broken down with the finger, the latter divided by the knife. Two of them present an insuperable impediment to reduction; namely, the natural means of connexion, and the close organized adhesions, if they be to a great extent, and the heraiia large. With regard to the two remaining conditions, the possibility of overcoming them, and the propriety of attempting to do so, must depend entirely on the particular circumstances of the case; but in many cases it is more judicious not to interfere with them, unless they exist only to
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