Origin of the epigastric and obturator arteries by a common trunk from the internal iliac : with an inquiry into the amount of danger occasioned by various positions of arteries in the ordinary operations for femoral and inguinal hernia / by P. Redfern.

  • Redfern, Peter, 1821-1912
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Origin of the epigastric and obturator arteries by a common trunk from the internal iliac : with an inquiry into the amount of danger occasioned by various positions of arteries in the ordinary operations for femoral and inguinal hernia / by P. Redfern. 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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    peai’ only two exceptions, one being in a case of internal labial nernia, recorded by F. C. Hesselbacli the other, Lauth’s case be- fore named. In Hesselbach’s case “ the obturator artery arose from the inner side of the crural more than half-an-inch distant from the internal inguinal ligament (transversalis fascia), and running for the length of an inch obliquely downwards and inwards over the crural vein, bent suddenly, on the horizontal ramus of the pubes, to- wards the obturator foramen; from this bend arose the epigastric artery, which proceeded transversely inwards on the horizontal ramus of the pubes, behind the neck of the hernial sac, and ascended on its inner side to get behind the rectus muscle of the abdomen, accompanying the ligamentous remains of the umbilical arteiy which were close behind it.” The epigastric artery is carried inwards to the edge of the rectus muscle by large oblique scrotal herniaB of long standing, but in no instance has it been found in such a position as to be endangered by the division of the stricture upwards, a plan now almost uni- versally adopted in all cases of inguinal hernia. Though, m ordi- nary cases, this artery could not be injured by the division of the stricture of an oblique inguinal hernia upwards and outwards, and that of direct inguinal hernias upwards and inwards, it has been fully shown that these different forms of inguinal rupture cannot always be distinguished from each other, and, consequently, that such methods of operating must occasionally lead to fatal results. Moreover, there are other sources of danger; for if, in such a case as Hesselbach’s above referred to, the stricture of an inferior direct hernia were to be cut upwards and inwards, the edge of the knife would be applied upon the epigastric arteiy, and a similar occur- rence would take place in the division of the stricture of an oblique hernia upwards and outwards, in any instance like that named oy Lauth and Velpeau. The following cases of injmy of important arteries, in operations for inguinal hernia, are on record :— 1. Scrotal hernia—Strictui’e cut by Sir A. Cooper * upwards and outwards; epigastric arteiy divided; hemorrhage stayed for four hours by pressure in the groin ; death in ten hom’S after operation ; abdomen distended with blood. 2. Inguinal hernia caused by the kick of a horse—Stricture cut upwards, and epigastric artery completely divided ; both ends were tied; ligatures were brought away on the eleventh day; tlie wound was healed on the fourteenth, and the patient returned to his work • Disquisitiones Anatomico-patliologicse de Ortu et Pi'ogressu Heniiaruin, cum Tabulis xvii. teneis. Wirceburgi, 181G, p. 15. 2 TJie Anatomical and Surgical Treatment of Inguinal Hernia, First Part, frondon, 1827, p. G9.
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