Interstitial herniae and their treatment / by W. McAdam Eccles.

  • Eccles, William McAdam, 1867-1946.
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: Interstitial herniae and their treatment / by W. McAdam Eccles. 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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    sacs, part of which may lie hidden and part of which may contain bowel which is nipped while other portions are free from the constricting force. For the two former forms of in- terstitial hernia the treatment when strangulated differs but little from that which would be followed in the case of an inguinal hernia which presented no peculiarities. Taxis is not to be recommended, I venture to believe, in the majority of strangulated hernise, but it is particularly to be avoided if possible in these interstitial ones. Operation should be under- taken at the earliest opportunity and an attempt made after relieving the constriction and returning the contents of the sac to radically obliterate its neck. Great care has to be exercised if taxis is employed not to mistake the reduc- tion of the contents of one part of the sac into another por- tion as complete return of the viscera into the abdomen. Again, the same caution must be taken when operating to be fully satisfied that all secondary parts of the sac have been thoroughly explored so that no imprisoned howel may remain unobserved. In instances where there is a true pro-peritoneal sac in addition to a scrotal, or labial, one, the condition which occurs when strangulation takes place in the hidden part is a difficult one to diagnose with certainty. Generally speaking there will be all the signs of intestinal obstruc- tion, but without the local ones of strangulation in the visible sac, which, however, may present some signs of inflammation. These cases should always be explored in the inguinal region without delay and if no secondary sac containing intestine is found then the case resolves itself into one of intestinal obstruction, the cause of which must lie within the general abdominal cavity, and an immediate laparotomy is called for. The actual strangulation in the third variety of interstitial hernia is usually at the common neck of the sac, but occasionally it is to be found at the entrance to the secondary hidden sac. In cases where reduction en masse has occurred and is evidenced by the continuance of symptoms of strangulation it is neces- sary to perform an operation and that without any delay. Thus the strangulation of an interstitial hernia is to be regarded with extreme suspicion and the prognosis which is given to be one of a guarded nature. In conclusion, I hope that even if this paper has in it not much that is new, yet that there may be something of practical interest to each one of us, for we may be any day called upon to treat such a form of protrusion as that known as an interstitial inguinal hernia. PRINTED AT THE liANCET OFFICE, 243, STRAND, W.O.
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