. Diseases of the stomach : including dietetic and medicinal treatment . ^ a combinationmethod. Rare Forms of Diaphragmatic Hernia.—A partial form of diaphrag-matic hernia occurs when a pouch-like projection of the stomach wallenters the diaphragmatic cleft. Only two instances of this partial orso-called Richters hernia have been recorded, and in neither caseis there any clinical history. One recorded by Andrew is quoted byKnaggs.^ A dome-shaped pouch of the diaphragm existed immediately to the 1 Lancet, August 6, 1904. 412 DIAPHRAGMATIC HERNIA left of the esophageal opening and into it a ])or
. Diseases of the stomach : including dietetic and medicinal treatment . ^ a combinationmethod. Rare Forms of Diaphragmatic Hernia.—A partial form of diaphrag-matic hernia occurs when a pouch-like projection of the stomach wallenters the diaphragmatic cleft. Only two instances of this partial orso-called Richters hernia have been recorded, and in neither caseis there any clinical history. One recorded by Andrew is quoted byKnaggs.^ A dome-shaped pouch of the diaphragm existed immediately to the 1 Lancet, August 6, 1904. 412 DIAPHRAGMATIC HERNIA left of the esophageal opening and into it a ])orti()n of the cardiac endof the stomach measuring \ertically al)out one inch was drawn. Thehernia couhi easily be pulled down and the part of the stomach wallthat lay against the neck of the pouch was thickened. In the other instance a pouch formed from the greater curvaturehad passed through an aperture in the diaphragm and had becomestrangulated. Fig. so. Stomach showing diverticuluin of cardiac end in the pouch of the iliaphiagin. (From theLancet, March 21, 1903.) Diaphragmatic Hernia with Gastroptosis.—Examples have occurredof extreme degrees of visceroptosis in which, owing to the descent ofthe diaphragm by the giving away of its support, the diaphragm atthe seat of the esophageal opening sags downward to a greater extentthan can be overcome by a downward traction of the esophagus, sothat as the diaphragm descends the esophagus pulls up the cardiacorifice of the stomach to such an extent that this portion of the organlies within the thorax and above the level of the esophageal or not such a condition would give rise to clinical symptomsis a matter of conjecture. The writer has encountered one instanceof esophageal diverticulum with the characteristic symptoms of cardio-spasm, in which obstruction to the passage of food from the esophagusto the stomach was apparently caused by a redundancy of mucousmembrane at the
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