. On retro-peritoneal hernia : being the 'Arris and Gale' lectures on the 'The anatomy and surgery of the peritoneal fossae' : delivered at the Royal College of Surgeons of England in 1897. the process of wandering of thehernial orifice. This artery, emerging from beneath thepancreas, crosses the duodenum, and in the increase of thefossa in this direction the duodenum becomes more and moreuncovered, until the whole of the anterior wall of the orificeof the sac is bounded immediately by the artery quite up to 56 THE DUODENAL FOLDS AND FOSS& the point of its emergence. The duodenum then, from fo
. On retro-peritoneal hernia : being the 'Arris and Gale' lectures on the 'The anatomy and surgery of the peritoneal fossae' : delivered at the Royal College of Surgeons of England in 1897. the process of wandering of thehernial orifice. This artery, emerging from beneath thepancreas, crosses the duodenum, and in the increase of thefossa in this direction the duodenum becomes more and moreuncovered, until the whole of the anterior wall of the orificeof the sac is bounded immediately by the artery quite up to 56 THE DUODENAL FOLDS AND FOSS& the point of its emergence. The duodenum then, from form-ing the upper boundary of the fossa, comes to lie in itsposterior wall at the upper extremity. This explanation ofthe enlargement upwards of the orifice is more than plausible,for a precisely similar occurrence is noted so far as Jhe lowerboundary of the aperture is concerned. Every intermediatestage between the condition where the aperture has theappearance presented by Dr. Barrs case to that presentedby the case of Gerard-Marchant (Fig. 21) has been this case, the most extreme of its kind, the whole of themesentery of the small intestine sprang from the anterior. Fig. 20.—Right Duodenal Hernia. (Barrs.)Orifice of the sac formed by the fossa of Waldeyer. margin of the orifice of the sac. This enlargement of theneck of the sac until the orifice reaches the caecum is inevery respect comparable with and parallel to the extensionupwards and unrolling of the peritoneum that I The n<*ck of the sac, in a word, behaves in api^cisely simi-Laffashion to the neck of every other hernialsac. fdOw^rifice enlarges almost or quite in proportion asthe saj:^«4arges. Cases very similar to this one have beenreported by Jackson Clarke and Neumann. Neumannscase has the additional interest attached to it that operationduring an attack of acute obstruction was followed byrecovery. So far this is the only case of recovery on record. THE NECK OF THE SAC 57 The secon
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