. Abdominal hernia : its diagnosis and treatment. , or it can be ascertained that the protrusionis actually extra-peritoneal, and it can be tlealt with accord-ingly. If the sac cannot be readily lifted from its posteriorattachments it should be suspected at once that it is eithersigmoid, csecal, or bladder hernia. When the finger is withinthe peritoneum, the anterior sac wall may then be carefully cutupon it with blunt scissors, care being exercised to avoidintestinal adhesions that may be present, and remembering theimmediate proximity of the epigastric artery. The contents ofthe sac mav then
. Abdominal hernia : its diagnosis and treatment. , or it can be ascertained that the protrusionis actually extra-peritoneal, and it can be tlealt with accord-ingly. If the sac cannot be readily lifted from its posteriorattachments it should be suspected at once that it is eithersigmoid, csecal, or bladder hernia. When the finger is withinthe peritoneum, the anterior sac wall may then be carefully cutupon it with blunt scissors, care being exercised to avoidintestinal adhesions that may be present, and remembering theimmediate proximity of the epigastric artery. The contents ofthe sac mav then be freely examined and so far as possiblereduced. SIGMOID: CJiCAL: BLADDER. 281 The second step in the operation is to separate theposterior wall of the bowel from its attachment. This may be(lone by gentlv pushing the fingers upwards between the boweland the deeper parts, exerting as little force upon the intestineas possible, and watching closely for broken vessels, whichshould be tied at once even though small. The point of separa- FiG. 15S,. Form of purse-string suture for sigmoid sac. tion between the structures should be carried well up into theabdomen so that the bowel can be reduced with perfect free-dom. It is necessary to exercise caution m pushing the bowelback not to telescope it into itself, thereby producing an intus-susception. Closure of the Sac (fig. 158).—It is quite obvious that asac of this type cannot be closed by an ordinary ligature, asits posterior wall is formed of bowel. It is best done by a 282 ABDOMINAL HERNIA. purse-string suture applied from tlie inside of the sac, goingwell up to the internal ring, or peritoneal surface on itsanterior wall, and approaching with caution that part attachedto the bowel. When this suture (usually no. 2 plain catgutused double) is tied, the sac is perforated, and any surplus ofsac wall that exists is. drawn up and Jigated outside the purse-string suture antl cut away. The ends of the sac ligature with Fig. isq.
Size: 1454px × 1718px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookpublisher, booksubjecthernia
