. Modern surgery, general and operative. al sac. 20 potential femoral sacs (sacs into which a hernia had not entered). Anacquired sac is due to intra-abdominal pressure bulging the peritoneal coveringof an abdominal ring and converting it into a pouch. The sac comprises abody, a neck, and a motith. A sac once formed is almost certain to persist, be-cause it adheres by its outer surface to siurounding parts, and hence the sacof a hernia is usually irreducible even when the contents are reducible. Theneck of the sac is due to the constriction through which the sac passes; it becomesfurrowed and
. Modern surgery, general and operative. al sac. 20 potential femoral sacs (sacs into which a hernia had not entered). Anacquired sac is due to intra-abdominal pressure bulging the peritoneal coveringof an abdominal ring and converting it into a pouch. The sac comprises abody, a neck, and a motith. A sac once formed is almost certain to persist, be-cause it adheres by its outer surface to siurounding parts, and hence the sacof a hernia is usually irreducible even when the contents are reducible. Theneck of the sac is due to the constriction through which the sac passes; it becomesfurrowed and folded, and the adhesion of these folds causes thickening and ri-gidity. Hernia of the bladder or of the cecum may have no sac or but a partialsac. A ventral hernia following an abdominal operation may be without asac. The contents of the sac depend chiefly on the situation, a portion of theileum being the usual contents. The colon, the stomach, the great omentum,the bladder, and other structures may enter the hernial sac. An enterocele. Fig. 814.—A diagrammatic repre-sentation of the coverings of a hernia:a, The skin,; b, the superficial fascia; c, the muscular layer—e. g., the cre-master muscle in an inguinal hernia; d, the transversalis fascia; c, d, havealso been called the fascia propriaherniae; e, the peritoneum—i. e., thesac of the hernia (Sultan). In .100 necropsies Murray found 12 74 Diseases and Injuries of the Abdomen contains intestine only; an epiplocele contains omentum only; an cntero-epiplocelecontains both omentum and intestine; a cystocelc contains a portion of the blad-der. The coverings of the sac, which vary with its situation, will be set forthduring the consideration of special forms of hernia. In old hernia the layersare never distinct, fat and muscle waste, tissues adhere, and the skin stretchesand atrophies. The sac of an old hernia occasionally becomes tuberculous, andthe disease may remain local in the hernial sac or spread to the general peri-
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