. Manual of operative surgery. Fig. 769.—Cranwells operation for diaphragmatic Pleura. D. Diaphragm. O. Omentum. C. Colon. ^earf^. Fig. 770.—(Carson, Interstate Med. Joiirn.) 628 RETRO-PERITONEAL AND DIAPHRAGMATIC HERNIA was opened by a flap having its base above, consisting of the whole thicknessof the chest-wall and containing about 5 inches of the ninth and eighth ribs(Fig. 769). In spite of numerous adhesions the prolapsed omentum and colonwere reduced, the openings in the diaphragm and in the pleura were suturedand the external wound closed. The patient recovered. The hernia was
. Manual of operative surgery. Fig. 769.—Cranwells operation for diaphragmatic Pleura. D. Diaphragm. O. Omentum. C. Colon. ^earf^. Fig. 770.—(Carson, Interstate Med. Joiirn.) 628 RETRO-PERITONEAL AND DIAPHRAGMATIC HERNIA was opened by a flap having its base above, consisting of the whole thicknessof the chest-wall and containing about 5 inches of the ninth and eighth ribs(Fig. 769). In spite of numerous adhesions the prolapsed omentum and colonwere reduced, the openings in the diaphragm and in the pleura were suturedand the external wound closed. The patient recovered. The hernia was dueto an old stab-wound which had healed. N. B. Carson (Interstate Med. Journ., April, 1912) reports a successfuloperation for diaphragmatic hernia (supposed to be of congenital origin), inwhich a correct diagnosis was made prior to operation. Insufflation anesthesiawas used and the intrathoracic structures were prevented from drying by beingsmeared with vaseline. The use of Carrels vaselinized silk napkins to protectthe lungs, etc., was found impracticable. It was necessary to resect severalribs before proper access was obtained.
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