. Abdominal hernia : its diagnosis and treatment. to remove large masses of omentum that have beenoutside the al)domen for some time, than to attempt its replace-ment, for two reasons: 262 ABDOMINAL HERNIA. (I) It has become shaped to the canal and to the sac thatcontains it. and if crowded back into the abdominal cavity, Fir. 142. A >^^ W \^m % i ^^^yr^-T^ ?P-. ?^Hp C w^ \ M^^^^St^^Kl: ^^ ^Mi ^ 1 JM!&,V^ 9p BUPIHi^^cyy^ , ^^^ s; L4«i^JflH |-^ i 1 ® ^ Omentum irreducible because of adhesions. A, Omentum. B, Neck of sac, C, Sac cutopen D, Fundus of sac with omeiilum firmly adherent. remains
. Abdominal hernia : its diagnosis and treatment. to remove large masses of omentum that have beenoutside the al)domen for some time, than to attempt its replace-ment, for two reasons: 262 ABDOMINAL HERNIA. (I) It has become shaped to the canal and to the sac thatcontains it. and if crowded back into the abdominal cavity, Fir. 142. A >^^ W \^m % i ^^^yr^-T^ ?P-. ?^Hp C w^ \ M^^^^St^^Kl: ^^ ^Mi ^ 1 JM!&,V^ 9p BUPIHi^^cyy^ , ^^^ s; L4«i^JflH |-^ i 1 ® ^ Omentum irreducible because of adhesions. A, Omentum. B, Neck of sac, C, Sac cutopen D, Fundus of sac with omeiilum firmly adherent. remains in a large mass at the internal ring ready to againdilate the canal and cause recurrence of the hernia. COMPLICATIONS IN SURGICAL CURE. 263 (2) Omentum long resident outside of the abdomenbecomes hypertrophied and so changed in character that it mayact as a foreign body when returned witliin the peritonealcavity. Formerly it was considered good surgery to take a massof omentum, such as shown protruding through the neck of the Fig. Oineiuum spread out before ligatiiig 10 isolate vessles and prevent risk of injuring intestine. sac in fig. 142, pass a ligature around it and cut it off. Workof this type was followed by fatal accidents from secondaryhaemorrhage, and in more than one instance, from injury tobowel that was lying unseen within the omentum. Many years since I advocated a method of ligation thathas become almost universally used by careful surgeons. It 264 ABDOMINAL HERNIA. consists ill drawing down tlie protruding mass until normalomentum is brought outside of the canal, being careful not tomake undue traction. It is then spread out by the hands (fig. Fig. 144.
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