. Abdominal hernia : its diagnosis and treatment. asit extended well around to back of thigh. Contents, intestine with a large mass of adherentomentum. Cured by operation. Hernire of this size are pretty sure to be made up largelyof omentum, as in this case, but the author has seen one casefully as large where the protruding content wasentirely intes-tine and irreducible. The case referred to is shown in fig. photograph fails to show the full proportions of thetumor, or another femoral hernia that existed on the oppositeside. This tumor also extended around to the inner side of 20 306
. Abdominal hernia : its diagnosis and treatment. asit extended well around to back of thigh. Contents, intestine with a large mass of adherentomentum. Cured by operation. Hernire of this size are pretty sure to be made up largelyof omentum, as in this case, but the author has seen one casefully as large where the protruding content wasentirely intes-tine and irreducible. The case referred to is shown in fig. photograph fails to show the full proportions of thetumor, or another femoral hernia that existed on the oppositeside. This tumor also extended around to the inner side of 20 306 ABDOMINAL HERNL\. the tliigh. Upon operating, the right-side hernia was found toconsist of intestine held upon a mesentery so thick and inflex-ible that reduction appeared, at first, impossible. No adhe-sions existed, and no omentum was found protruding. Reduc-tion was finally accomplished and the greatly distended femoralopening closed. The opposite side was also operated patient, more fortunate than my one other instance of Fig. Double femoral in aged 48 years. Right side only shown and not in its fullsize. Irreducible. Contents, intestine held down by hypertrophied mesentery. No adhe-sions. No omentum. Both hernias cured by operation 011 the same day. mesentery of this i)eculiar type, made a prompt recovery andremains sound four years later. No truss has been worn. The dangers of acute strangulaton are not quite as greatin hernias of such large size as in the smaller ones, inasmuch asthey protrude through such enormously distended rings; theyare quite likely, however, to eventually reach a fatal termina-tion where the bnwel forms a large part of the protrudingcontents and is irreducible. This cOmes, first, with obstinateconstipation, gradually increasing to intestinal olistruction anddeath. It is due to the fact that the bowel, in its al)normalposition, under pressure at the abdominal orifice, gradually FEMORAL HERNIA. 307 loses its peristalti
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