Operative surgery . , and the patient recovered. After returning the protrusion thewound is closed and dressed antiseptically. Femoral herniae do not always follow the course just described ; theytake, though infrequently, anomalous courses, sometimes appearing at theouter side, or behind the femoral vessels. They have been known to passthrough Gimbernats ligament. It is important to know that in all theanomalous cases the neck of the sac lies closely associated with the epi-gastric artery alone, or together with the obturator, and troublesome andeven fatal hsemorrhages may be caused unless ca
Operative surgery . , and the patient recovered. After returning the protrusion thewound is closed and dressed antiseptically. Femoral herniae do not always follow the course just described ; theytake, though infrequently, anomalous courses, sometimes appearing at theouter side, or behind the femoral vessels. They have been known to passthrough Gimbernats ligament. It is important to know that in all theanomalous cases the neck of the sac lies closely associated with the epi-gastric artery alone, or together with the obturator, and troublesome andeven fatal hsemorrhages may be caused unless care is taken in dividing theconstriction. The Results.—The general death rate after operation for strangulatedfemoral hernia is about 24 per cent. Strangulated Umbilical Hernia.—Umbilical hernia^ appear at all ages oflife and in response to devious causes. The symptoms of strangulation aregenerally acute, although large, old, and persistent protrusions of this kindsometimes do not cause pronounced Fig. 1121.—The curve of the obtu-rator artery and consequent rela-tion to Gimbernats ligament (*). urHKATlONS ON VISCEUA CONNECTED WITH 913 Tlie Operation.—After thorough cleansing of the surface, make anelli])tical incision at the median line broad enougii to include the super-abundant tissue; deepen the incision at one side down to the aponeuroticstructure; reflect this half of the ellipse toward the median line, thus expos-ing the neck of the sac and the margin of the hernial opening at that side;repeat the step at the opposite side, thereby isolating the hernial opening,the neck and body of the sac, the latter still bearing the integumentaryellipse; open the sac at the point farthest from adhesions and at the lowerbonier, if i)racticable; expose and examine the contents; remove omentum(Figs. llUlt ;ind 1110), retain and repair gangrenous intestine, enlarge thehernial orifice above and below and return the sound parts to the belly;sever the neck
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