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
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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![23. Schindler^ witnessed the death of a female from division of tlie epigastric artery, in an operation for femoral hernia.^ Notwithstanding that the records of many of the above cases are very imjierfect, they are of considerable value in connection with the anatomy of the vessels before named; for, whilst it is proved, on the one hand, that large vessels have occasionally such relations to the neck of a crural hernia as seem to place them in the* greatest danger from the incisions ordinarily made for the relief of the stric- ture of such a hernia, there can, on the other hand, be no doubt that such vessels have, on many occasions, been injured, and that fatal hemorrhage has resulted from operations performed with great care by very eminent surgeons. In these respects there is a re- markable difference between inguinal and femoral hernia; in the former, no vessel has been shown to have been injured in any single instance by tbe division of the stricture upwards w'hen the part had been fairly exposed, nor has any vessel been seen in a position in which it could have been injured by such a proceeding; in the latter, the division of the strictui’e inwards, upwards, or outwards, has alike proved fatal from hemorrhage, and we have the best rea- sons for believing that such accidents will continue to recur, in a ' small proportion of cases, unless tbe possibility of arteries lying across the recognised lines of incision of the stricture be borne in mind, and the greatest care be exercised in all such operations. The necessity of accurate diagnosis is so apparent as to need little comment, for to mistake an inguinal for a femoral hernia, or the reverse, and to oper- ate upon it with such a mistaken impression, must necessarily lead to death from hemorrhage in a considerable number of in- stances. Lastly, in the instances in v/hich a femoral hernia does not pass through the canal, but appears under some other pai’tof the crural arch, and becomes strangulated, nothing but an accurate diagnosis of the position of the hernia, and a precise anatomical knowledge of the position and connections of the parts with which it must come into relation, can warrant a departure from the ordinary method of operat- ing, and save the patient from the risk of fatal hemorrhage to which he would be subjected by the performance of the ordinary operation for femoral or inguinal hernia. > H. T. Schindler. Diss. de Ilerniis Observationes et Melctemata qutedani. Wittenberg, 1796. 2 It is possible that all tbe cases referred to in Nos. 10, 17, 18, 19, 20, and 21, did not occur as individual instances, but that tbe same case, or cases, were observed and mentioned by sevei'al persons, though there is nothing to enable us to identify them. MM. Itocbe and Sanson state, that llupuytren never wounded tbe epigastric artery; but we have tbe positive evidence of Dr A. Thomson, that that eminent surgeon wounded tlie e])igastric on three occasions, whilst Dr Reid saw him divide the obturator directly across.](https://iiif.wellcomecollection.org/image/b22333290_0024.jp2/full/800%2C/0/default.jpg)
