. Abdominal hernia : its diagnosis and treatment. rgely due to the distribution of the peritoneum. The pro-trusion takes place at a point where the peritoneum leaves theabdominal wall and is reflected over the pelvic organs. Whenit is carried through the abdominal wall it drags, by its at-tachments to them, one of these organs with it. This is espe-cially true of the large bowel on either side and the bladder,on account of their being freely movable and conveniently 277 278 ABDOMINAL HERNIA. placed. While the peritoneum completely surrounds the smalland in some parts the large intestine it cov
. Abdominal hernia : its diagnosis and treatment. rgely due to the distribution of the peritoneum. The pro-trusion takes place at a point where the peritoneum leaves theabdominal wall and is reflected over the pelvic organs. Whenit is carried through the abdominal wall it drags, by its at-tachments to them, one of these organs with it. This is espe-cially true of the large bowel on either side and the bladder,on account of their being freely movable and conveniently 277 278 ABDOMINAL HERNIA. placed. While the peritoneum completely surrounds the smalland in some parts the large intestine it covers only the anteriorsurface of both the sigmoid flexure and caecum. It is for thisreason that a portion of the large bowel on either side mayprotrude without a hernial sac, and if not recognized by theoperator may be opened by mistake. Tuffier (Etude sur lecacmn et les hernies. Arch Gen. de Med., 7th ser., vol. xix, ) found in the examination of 100 bodies that 9 per cent,had the posterior surface of the caecum uncovered by peri- FiG. Sac wall Hernial sac coiilailling fiee csecum and loops of small intestine. toneum. The bladder is covered by peritoneum upon itssummit and a small portion of its posterior wall, but not itsanterior wall. When this distribution of peritoneum is considered it willbe readily understood how any one of these organs may pro-trude in either one of three conditions: (i) It may become apart of the hernial contents, in a prefonned sac—intra-peri-toneal (fig. 156). (2) It may protrude independently, with-out any serous covering—extra-peritoneal (fig. 157). (3) Itmay be dragged down in the formation of the hernial sac and SIGMOID: C^CAL: BLADDER. 279 have a partial peritoneal covering, and become both intra- andextra-peritoneal. As previously stated, protrusions into a preformed sachave not been considered by the author to constitute eithersigmoid, Ccccal, or bladder hernia, because they are easilyreduced with the other hernial contents, quic
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