. Abdominal hernia : its diagnosis and treatment. -operative ventral hernia. Perforating gun-shot wound. Entrance of ball gluteal, exitinguinal region. Hernia the result of operative attempts to close suppurating sinus. A few years ago the operation for the removal of theappendix, even where no aljscess existed, involved the cuttingdirectly across, with consequent destruction of, the internaloblique muscle, and all the nerves and blood vessels with whichthis region is so richly endowed. Complete restoration of theparts was practically impossible and hernia resulted in a largeproportion of case
. Abdominal hernia : its diagnosis and treatment. -operative ventral hernia. Perforating gun-shot wound. Entrance of ball gluteal, exitinguinal region. Hernia the result of operative attempts to close suppurating sinus. A few years ago the operation for the removal of theappendix, even where no aljscess existed, involved the cuttingdirectly across, with consequent destruction of, the internaloblique muscle, and all the nerves and blood vessels with whichthis region is so richly endowed. Complete restoration of theparts was practically impossible and hernia resulted in a largeproportion of cases. This in some abscess cases may, even 390 ABDOMINAL HERNL\. now, be a necessity as a life-saving measure, but most surgeons,in this country at least, ha\-e learned that quite extensive workcan be done in this region by splitting each muscle in the direc-tion of its fibres and holding them apart by retractors. Wherethe abdomen is entered by this method and deep drainage is notrequired ventral hernia ven, seldom results. The case shown Fig. Front view of previous case. in fig. 214 and 215 is of rather unusual form, and resulted fromthe indiscriminate cutting away of the muscles of the lowerabdomen in an attempt to cure a sinus following a gunshotwound. The sinus was of very little importance when it isconsidered in connection with the hernia that was the directresult of the operative work, which also failed in its originalpurpose. VENTRAL HERNIA. 391 Traumatic ventral hernia: are as varied in size and shapeas the patients are numerous. When the protrusion once startsit increases rapidly unless checked by suitable and prompt treat-ment. In its passage through the wall there are usually somefibrous bands which retard a portion of the tumor and causeit to become irregular in shape: it may come out on both sides Fig. 216.
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