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Show 198 or ran omnxrnm. OF THE OrIENTUM. ends of the intestine when they have been cut, will occur, I conceive, that in these cases which may seem to indicate and require such an operation, we should do better to treat When the stricture of the omentum proceeds to great lengths, then the tumour inflames, and proceeds through the stages to suppuration; while the inflammation runs retrograde upon the omentum, within the belly. A greenish yellow betrays the actual gangrene of the omentum during operation. The omentum contained within a herniary sac, changes rcmarkably from its natural state. It assimilates into a mass ; its lobes become large ; it is loaded with fat; and strings of adhesion connect the several masses; or it forms a round, smooth ball, by its condensation, having only a connection with the omentum within the belly by a narrow somewhat tendinous neck. My preparations assure me of the truth of Pott's remark-" All that part which passes through what is called the neck of the sac, is by constant pressure formed more simply. The stricture being undone, I should be inclined to let the intestine remain in the sac. If there should happen to be an accidental cut in the intestine, or if the intestine has gangrened and burst, a free discharge of the contents of the upper part of the canal should be allowed before any attempt is made to unite it by ligature, or to reduce the intestine; because no quiescence can be expected in the portion of the gut wounded, until the accumulated contents of the upper portion of the intes~ tines have passed it, or are evacuated. OF THE OMENTUM, 'l'na epiplocele is a troublesome disease, not so immediate ly dangerous as the intestinal hernia ; but still, from the ex- posure of the tumour to blows, and the omentum being precursor to the falling down of the intestine, it is a disease requiring attention. The truss for this kind of hernia must be used with precaution, as if the omentum be not kept entirely up, by pressing upon it inflammation may follow. Upon its first descent, this hernia is often attended with pain in the abdomeni"; "I ,1 into a hard, firm, incompressible, carious kind of body, incapable of being expanded, and taking the form of the passage in which it is confined, exactly filling that passage, and ren‘ dering it impossible to push up the loose part of it which fills the scrotum." When the omentum in a natural state escapes from the belly, in consequence of a wound, I have seen it impossible to reduce it, in consequence of its extreme delicacy; and hav-ing been torn and mashed in the attempt, it was found necessary to cut it oli‘. Mr. Hey, I see, thinks it possible " that when the omentum is in a state tending to gangrene, though not appearing unsound, it may suffer irreparably from a de- In the symptoms of omental hernia, there is this distino gree of pressure in the reduction, which would not have injured it had it been perfectly soundae." We have many occasions, then, for cutting 011‘ the great- tion from the intestinal, that stools can be procured. The hiccups, too, are less violent and constant; the pulse some- er part of the omentum, as this consolidation and growing together ; (sometimes it becomes like schirrus); adhesions to what fuller; the belly not so tense; and the disease has a the sac; gangrene. longer course. we must spread it fairly out, and unravel it, that no portion To the feeling there is an inequality in the Preparatory to cutting the omentum, tumour, 3‘ Mr. Hey and Mr. Warner describe :1 particular crossness or brittleness, A: affording D a more distinguishing ._. U marl; of ursoun ness than the lividitv , of r, n :1" owzrut'nn. ' "SK-it'd?- Qfix'mh-v‘ A and then it greatly resembles a strangulated intestinal her; nia. But if the patient can retain light food and purgative medicines upon his stomach, there is usually no necessity for performing the operation. 199 wow M09917" * |