. On retro-peritoneal hernia . Dr. Barrs case to that presentedby the case of Gerard-Marchant (Fig. 21) has been this case, the most extreme of its kind, the whole of themesentery of the small intestine sprang from the anteriormargin of the orifice of the sac. This enlargement of theneck of the sac until the orifice reaches the caecum is inevery respect comparable with and parallel to the extensionupwards and unrolling of the peritoneum that I have THE NECK OF THE SAC 63 described. The neck of the sac, in a word, behaves in aprecisely similar fashion to the neck of every other hern
. On retro-peritoneal hernia . Dr. Barrs case to that presentedby the case of Gerard-Marchant (Fig. 21) has been this case, the most extreme of its kind, the whole of themesentery of the small intestine sprang from the anteriormargin of the orifice of the sac. This enlargement of theneck of the sac until the orifice reaches the caecum is inevery respect comparable with and parallel to the extensionupwards and unrolling of the peritoneum that I have THE NECK OF THE SAC 63 described. The neck of the sac, in a word, behaves in aprecisely similar fashion to the neck of every other hernialsac. The orifice enlarges almost or quite in proportion asthe sac enlarges. Cases very similar to this one have beenreported by Jackson Clarke and Neumann. Neumannscase has the additional interest attached to it that operation. Fig. 21 -Kight Duodenal Hernia, showing the Orifice of the Sac BOUNUKO BY THE SUPERIOR MESENTERIC AND IlEO-COLIC ArTERIES.(Ge RARD-M ARCH ANT ) (luring an attack of acute obstruction was followed byrecovery. So far this is the only case of recovery on second case, which I have examined closely, is onewhich has been preserved for some years in the post-mortemroom of the Leeds Infirmary by Dr. Griffith. The historyof the patient is not recorded. • 64 THE DUODENAL FOLDS AND FOSSM The case is a most typical one. The hernial sac passesbehind the superior mesenteric artery, and ^^ets to the outerside of the ascendinjs^ colon, which has a distinct, well-definedmesentery about i inch in len<^th. The whole of the smallintestine, from the duodenum to the caecum, is containedin the sac. There is no jejunal adhesion to the posteriorabdominal wall. The orifice of the sac is bounded by thesuperior mesenteric artery and its continuation, the ileo-colic,and extends from the duodenum t
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