. American practice of surgery ; a complete system of the science and art of surgery . bands is impossible. Extirpation of the sac is practicallyimpossible in its inaccessible location. It must be left in situ, with the possi- 612 AMERICAN PRACTICE OF SURGERY. bility of its forming a cyst. The ring itself may be closed by sutures if greatcare is taken to avoid the encircling arteiy. Hernias of the Diaphragm.—Something over fi\-e hundred cases of herniaof the diaphiagm are now on record, and almost two-thirds of them were con-genital. Thoma collected 433 cases, of which only 181 were acquired;
. American practice of surgery ; a complete system of the science and art of surgery . bands is impossible. Extirpation of the sac is practicallyimpossible in its inaccessible location. It must be left in situ, with the possi- 612 AMERICAN PRACTICE OF SURGERY. bility of its forming a cyst. The ring itself may be closed by sutures if greatcare is taken to avoid the encircling arteiy. Hernias of the Diaphragm.—Something over fi\-e hundred cases of herniaof the diaphiagm are now on record, and almost two-thirds of them were con-genital. Thoma collected 433 cases, of which only 181 were acquired; theremainder (252) were congenital. In 248 cases Lacher found that a sac wasreported only 24 times. These diaphragmatic hernias have also been classifiedas tme hernias—, hernias ha\dng peritoneal sacs, while false hernias merelyconsist of openings in the diaphragm through which the \dscera escaped. Thefonner, the tiTie hernias, constitute only one-tenth of the whole number reported.(Figs. 250 and 251.) Congenital absence or weakening of the central tendinous portion of the. Fig. 250.—Diaphragmatic Hernia Exposed to View by Dissection of the Pleural and PeritonealCa^•ities. This is a true hernia, , it has a hernial sac. (From Enderlen and Gasser.) diaphragm allows the escape of intestine and stomach, especially on the left side,into one or both pleural ca\ities. In acquired hernia the conditions are thesame, the cause being a wound or nipture of the diaphragm. In some con-genital cases the hernia has a tme sac, especially at the oesophageal or the para-sternal opening. As might he expected from its location the stomach is mostfrequently found in the hernial sac. Rochard, in 330 cases, found that thedifferent abdominal organs formed a part of the hernia in the following order offrequency:— Stomach 187 Duodenum 48 Colon 17 Csecum 35 Intestine 133 Pancreas 12 Spleen 78 Left kidney 2 Liver 60 Right kidnev 1 AI^DOMTNAL HERNIA. 613 In 266 cases of hernia of the diaph
Size: 1446px × 1728px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
