. Modern surgery, general and operative. as formerly the custom to support a small irreducible hernia by a hollow,padded truss, but now operation should be advised. A large hernia of thisvariety, if operation be refused, must be carried in a bag truss. The patientmust not take very active exercise, must keep the bowels regular, and must liveupon a plain diet. Most cases of irreducible hernia should be treated byoperation. Incarcerated or Obstructed Hernia.—Obstruction takes place by the dam-ming up of feces or of undigested food, the fecal current being arrested, but theblood-current in the wa
. Modern surgery, general and operative. as formerly the custom to support a small irreducible hernia by a hollow,padded truss, but now operation should be advised. A large hernia of thisvariety, if operation be refused, must be carried in a bag truss. The patientmust not take very active exercise, must keep the bowels regular, and must liveupon a plain diet. Most cases of irreducible hernia should be treated byoperation. Incarcerated or Obstructed Hernia.—Obstruction takes place by the dam-ming up of feces or of undigested food, the fecal current being arrested, but theblood-current in the wall of the bowel not being cut off. Incarceration is com-monest in irreducible hernia, especially umbilical hernia, and during the exis-tence of constipation. The hernia enlarges and becomes tender, painful, anddull on percussion; pressure may diminish it somewhat in size. It remainsirreducible, but still presents impulse on coughing. The abdomen is somewhatdistended and painful; there are nausea, constipation, and not unusually slight. Fig. 842.—Outline of per-itoneal lining of sac utilized asa flap to cover posterior sur-face after it has been freed bydissection (Weir). Strangulated Hernia 1291 vomiting. Constitutional disturbance is trivial and constipation is not absolute,gas at least usually passing. Vomiting is not fecal. The treatment is rest in bed in a position to relax the belly, an ice-bag overthe hernia for a very few hours, and a little opium for pain. Do not give aparticle of food for twenty-four hours; when the active symptoms subside givean enema, and, after this acts, a dose of castor oil. Do not employ taxis, asbruising the bowel may produce strangulation. If improvement does notrapidly occur, operate. Prompt operation saves the patient from the dangerof strangulation and cures the hernia. Inflamed Hernia.—Inflammation of a hernia is local peritonitis due toinjury of an irreducible hernia. The mass becomes tender and painful, andperhaps heat is noted. In
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