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
Catalogue details

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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    tinned for some time. At 3 a.m. on Monday, she had another attack of vomiting, which was followed by an interval of comparative ease, until 3 p.m., when the pain and vomiting increased in violence. She sent for Dr Thomson late in the evening, but made no mention of the swelling. A purgative was ordered, and an enema directed to be given. On Tuesday Dr Thomson found that the vomiting had become more fre- quent, and that the medicines had not acted ; lie tlien examined for, and detected the femoral hernia, and tried to reduce it whilst she was under the influence of chloroform, but did not succeed. In the evening her counte- nance w’as anxious, and she was restless, but the pulse not much affected. The vomiting had become feculent. On Wednesday morning Dr Thomson was told her bowels had been moved, but without any relief, and, on examining the stool, it w’as evidently from the lower bowel. 1 saw her wdth Dr T. about 3 p.m. on Wednesday ; her feature were sharp ; pulse quick and small ; abdomen distended ; the tumour tense and painful, and the skin over it was of a dusky colour. The matter vomited was evidently feculent, and she had occasional attacks of hiccough. Under these circumstances I made no attempts at reduction, but proceeded to operate after the administration of chloroform. On exposing the sac I found the textures infiltrated with inflammatory exudation, and matted together. The neck of the sac was very tightly constricted, and 1 required to use great caution in opening it, as there w'as no fluid between it and the bowel ; indeed, they were adhering at some points by recent lymph. The bowel was very dark, of a dull granular appearance, and very tightly constricted. On dividing the stric- ture I drew down the bow^el above it, and finding it of a natural appearance, I reduced the protrusion, and dressed and bandaged the wound in the usual way. Dr Thomson informed me that the urgent symptoms were relieved by the operation, and that the patient speedily recovered. Case III.—Mrs W., a;t. 64, of spare habit of body, and long subject to dys- pepsia, sent for Dr Maine of Gorebridge on the 2d of November 1854, stating that she had been suffering from an attack of pain in the stomach, and had vomited twice. As she was subject to frequent attacks of vomiting, this did not attract special attention, until next morning, when Dr M., finding that she had j>assed a bad night, that her bowels had not been opened, and that the vomiting had been more frequent, examined for, and detected a femoral hernia. She had been long aware of the existence of the swelling, but thought it of no consequence, as it used to go away of itself. Dr M. tried reduction by taxis, but without success ; and as she had vomited some stercoraceous matter, he gave her an opiate, directed cold to be applied to the swelling, and sent for me to visit the patient. It was late in the evening before I saw her ; she was then much exhausted with the vomiting and pain ; pulse quick and small ; skin covered with cold perspiration, and great pain in the abdomen. I put her under the influence of chloroform, and exposed the hernia by a T incision. From the severity of the symptoms, and the doubt as to how long the hernia might have been strangulated prior to her applying for medical aid, 1 determined to open the sac. As there seemed to be a little fluid at the lower part, 1 jjinched up and opened the sac at that point, and exposed a ])ortion of bowel of a very dark colour. On trying to pass my finger, 1 found the sac connected to the bowel, by old adhesions, over its whole surafce, so as to prevent even a thin flat director from being passed at any point, and this adhesion considerably lower than the seat of strangulation ; 1 therefore pro- ceeded to divide the falciform process and lower crural arch fully, so as to open the sac in the femoral canal above the constriction, and then divide it from above downwards. In doing so, when 1 had divided the textures over the neck of the swelling, it became flaccid, and was so evidently relieved, that 1 returned the adherent portion of the sac and bowel together.* 1 did not see the patient again, till she came to town to get a truss fitted; but I am indebted to Dr Maine for the following report of the case :— ;