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Show fJUU or ran WOUND AFIER REDUCTION. DISQUISITION on me sac or THE HERNIA. of the intestine be included in it. The remaining edge of the omentum bleeds proportionate to the quantity cut ofl‘; so that, to prevent a coagulum of blood being lodged in the belly, we must either include the whole mass of the omentum in a ligature, or take the vessels up with the tenaculum. The latter method is to be preferred; for the tying of the end of the omentum is but substituting a ligature for the stricture of the belly; nausea and vomiting; in short, peritoneal in1 ilammation, and death, may follow this. I have certainly seen a ligature put about the whole pro‘ cess, without a wrong symptom ; but it was done in the natu be continued through the length of the contracted channel, or the consequence will be fatal, notwithstanding the intestine be restored into the belly. On this account the operator be a cause of great alarm and danger. If the omentum is tum, before it be reduced. Let. care be taken also that it do not slip up into the belly, which a motion of the patient, or perhaps of the bowels, will cause it to do. If the omentum be entirely dead and gangrened, it were perhaps as well to look that no stricture remains upon it, and to take the greater mass only away, and leave part of it to re main, which will afterwards cast off. But if it be in part diseased, in part destroyed, if left it will grow into a fleshy irregular mass, requiring afterwardsto be extirpated. Sec l-ley's Surgery. OF Tllll \VOTJND AFTER REDUCTION. Tin: integumcnts (but not the sac) are to be brought to» - . SHARPE, after speaking of the manner of cutting the neck of the sac, continues-" If, upon examination, it shall appear that the intestine is strangulated within the abdomen, which may possibly happen from a contraction of the peritoneum, near the entrance into the sac, in that case the incision must cut, the intestine should be first reduced, that the flow of blood may be perfectly free to the cut vessels of the omen. - FURTHER DISQUISITION ON THE SAC OF THE HERNIA. of the omentum; so that restlessness, anxiety, and fever; pain ral state of the membrane, when its softness yielding, the lig ature came away on the second day. A ligature remaining about a firm tendinous mass of omentum, I should imagine to «i-E-‘a sgagg‘.«:y.¢_ w..- 201 getherby one or two stitches. These may be supported by adhesive straps. Above this a soft compress of lint and of 01d linen is placed, and the whole secured by a roller passed 115 3 spica bandage. Let the patient apply his hand on the dress- Jugs when inclined to cough, or when he wishes to have his bed or clothes shifted. should pass his finger up the sac, into the abdomen, after the reduction of the gut, in order to discover whether it be safely returned into its proper place. The opening being made, the intestine is gradually to be pushed into the abdomen," &c. Sharpe's Operations, ninth Edition,page 26. The original Munro observes, " after the bowels are reducu ed in appearance, the surgeon ought to search with his finger lest there be any contracted ringlet, cross bars, or productions of the peritoneum above the ring of the muscle, which might continue the strangulation of the gut, that they may be cut to make the gut quite free. Such rings," he continues, "are most readily to be met with in people who have long worn trusses." In Mr. Hey's tenth case, he thus expresses himself-" The stricture was not formed by the ring, but entirely by the neck of the hernial sac, into which I could not introduce my finger. I was obliged to divide the ring pretty high, that I might with safety divide the neck of the sac ; and this last division was effected by cutting along the groove of a director, till I had made a sufficient aperture for the introduction of my finger." In his remarks upon this case he continues-" This case affords a decided instance, in addition to others already published, that the neck of the hernia] sac is capable of becoming so contracted as to produce a fatal strangulation." It has appeared to me, in the following instance, exactly as it is here represented. iron. 1. A part of the colon was included in r2 won M099!!! |