. 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. tum was found rolled up alongthe greater curvature of the stomach. The whole of the smallintestine was distended. Some 4 or 5 inches of the terminalparts of the ileum were still found within the hernial had passed in with the caecum, but was only partially 154 HERNIA INTO THE LESSER PERITONEAL SAC strangulated. The 2 or 3 feet of ileum that had been reducedduring the operation were indicated by a
. 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. tum was found rolled up alongthe greater curvature of the stomach. The whole of the smallintestine was distended. Some 4 or 5 inches of the terminalparts of the ileum were still found within the hernial had passed in with the caecum, but was only partially 154 HERNIA INTO THE LESSER PERITONEAL SAC strangulated. The 2 or 3 feet of ileum that had been reducedduring the operation were indicated by a purplish discolora-tion as compared with the rest of the intestine. At the seatof stricture the colon was in front of the small intestine. Ofthe strangulated colon the caecum was the part that hadsuffered least. There was a descending mesocolon ofmoderate length. The colon may be described as beingvery sharply bent upon itself at the foramen of situation of this acute bending—the seat of the stricture—would correspond to about the centre of the transversecolon. The bowel from this point to the top of the caecumwas involved in the strangulation. The remaining (distal). Fig. 38.—Section (Diagrammatic) of the Abdomen at the Level of theForamen of Winslow, showing the Hernia in situ. (Treves.) half of the transverse colon was dilated by reason of theabrupt manner in which the bowel was again bent uponitself at the splenic flexure. This portion of the intestine(the distal half of the transverse colon) showed merely theeffects of great distension. In other respects it was was, of course, no trace of a hepatic flexure. Therewas a considerable degree of peritonitis in the epigastric area,and a few fresh adhesions united the ascending colon to theliver. The liver showed no morbid change of any stomach was merely distended. All the other viscerawere perfectly normal. It was evident that the caecum was undescended, and had led the way through the fo
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