A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . oneum (sac). Very oftenthese coverings are so thin that there isscarcely anything outside of the herniabut the skin and the peritoneum. Inadults this hernia may become very largeand it is frequently more or less irre-ducible. Obstruction is not uncommon ;strangulation is comparatively rare. Treatment.—In infants the conditionis often cured spontaneously. Neverthe-less, it is wise to keep the hernia reducedby placing over the umb
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . oneum (sac). Very oftenthese coverings are so thin that there isscarcely anything outside of the herniabut the skin and the peritoneum. Inadults this hernia may become very largeand it is frequently more or less irre-ducible. Obstruction is not uncommon ;strangulation is comparatively rare. Treatment.—In infants the conditionis often cured spontaneously. Neverthe-less, it is wise to keep the hernia reducedby placing over the umbilicus a pad heldin place by means of adhesive plaster ora bandage. A large coin or a piece of corkwrapped up in adhesive plaster with theadhesive side out may be applied withgreat satisfaction. The adhesive surfaceof the plaster keeps the coin from slip-ping, and a broad strip of adhesive plas-ter carried over the whole with the endsreaching the back makes a convenient dressing. It should be employedfor several months, being renewed about once a week; at which timethe skin should be washed. In adults an umbilical truss or an elasticbandage should be Large umbilicarjiernia. (Authors case.) 686 HERNIA. If strangulation occurs, an incision for the relief of the stricture isdemanded. The external wound is usually made over the top of thetumor. It does not make very much difference in what direction theconstricting band is divided, as there are no structures of importancearound the umbilical aperture. An upward incision, however, is prob-ably the most desirable. In opening the sac great care should betaken, because the coverings are so thin that the intestine may besuddenly and unexpectedly wounded. The protruding omentumshould be ligated and excised, after which the stump should be re-turned. Any portion of intestine hidden from view by thickenedomentum should be carefully searched for, since the strangulation ofgut may be unrelieved unless the intestine is fully inspe
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