Case of femoral hernia, containing the caput coecum, and complicated with an irregular obturator artery surrounding and constricting the protrusion, and other cases illustrative of the operation for femoral hernia / by James Spence.
- Spence, James, 1812-1882.
- Date:
- 1855
Licence: Public Domain Mark
Credit: Case of femoral hernia, containing the caput coecum, and complicated with an irregular obturator artery surrounding and constricting the protrusion, and other cases illustrative of the operation for femoral hernia / by James Spence. 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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![lastj not leastj tliG state of the bowel from the previous attempts at the taxis, forbidding all further pressure or manipulation that could possibly be avoided. The foim and connections of the ccecum always render its reduc- tion slow and gradual, even under more favourable circumstances, where the bowel can safely bear moderate compression, and where the constricting textures have been very freely dmded,—as I found in a case of inguinal coecal hernia, on which I operated some months ago, where there was no limitation to making the incision of the constriction very free indeed; and I have also seen the same diffi- culty, though to a much less degree, in cases where the sigmoid flexure of the colon formed the contents of inguinal hernias. In femoral hernia, however, where our incisions must, in general, be much more limited, and, especially, when w'e have ascertained the ])i*esence of an iiTegular ai’tery round the upper part of the ring, the causes of difficulty I have alluded to become very embarrassing, and require us to adopt great caution in dividing the constricting tex- tures ; indeed, it was the eccentric pressure of the bulky distended gut, which brought it into contact with structures which do not ordinarily form the seat of stricture, and in this way the irregular artery, dragged and stretched to the utmost by the distended portion of the ccecum, had come to form a cord-like constriction upon it, re- quiring division before the bowel could be returned. As to the plan to be adopted in such cases of femoral hernia, re- quiring such free incisions to relieve the bowel, I can only say that, after much consideration of this case, I would still proceed to divide the superimposed textures by the same method,—viz., by dissecting cautiously through the lower division of the tendon of the external oblique, and the other textures, down to the peritoneum, in a line corresponding to the centre of the femoral ring, the chord being drawn aside. Thus all danger of wounding the artery accidentally is avoided, and if it be found itself constricting the swelling, it will not be found very difficult to bring it into view and put ligatures upon it. Indeed, this plan is that which Sir Astley Cooper recommended as safest and best in all cases of large femoral hernia ; and, although I cannot think, after some experience in femoral heniiaB, that it is either necessaiy or advisable as a general plan, it will be found the safest in complicated cases requiring more than usually extensive incisions; it is, in fact, a cautious dissection down upon the upper part of the sac, or the parietal peritoneum immediately above, and continuous with it, and if carefully conducted, attended neither with difficulty nor danger. Case II.—Christian A., let. 72, residintf in Dalkeith,first noticed a swelling in the groin on the morning of Sunday, 17th September 18.54. During the day she was sick and much pained, and in the afternoon felt a strong desire to have motion in the bowels, whicli was accompanied with severe straining, but with- out any evacuation. She took some brandy to relieve the colicky pains, and tlien a dose of castor oil; shortly after which, vomiting commenced, and con-](https://iiif.wellcomecollection.org/image/b22368504_0012.jp2/full/800%2C/0/default.jpg)
