On retro-peritoneal hernia . wing condition : The intestines were injectedand distended with flatus, but there was no effusion of moving them aside to the right, it was observed that thesigmoid flexure was displaced towards the middle line, andextending from its posterior surface towards the left iliacfossa was a sheet of peritoneum, through an opening inwhich a knuckle of small intestine passed. The protrudedintestine was withdrawn without the least resistance, andproved to be a portion, about 6 inches in length, of the lower HERNIA INTO THE INTERSIGMOID FOSSA 121 end of the ileum. I
On retro-peritoneal hernia . wing condition : The intestines were injectedand distended with flatus, but there was no effusion of moving them aside to the right, it was observed that thesigmoid flexure was displaced towards the middle line, andextending from its posterior surface towards the left iliacfossa was a sheet of peritoneum, through an opening inwhich a knuckle of small intestine passed. The protrudedintestine was withdrawn without the least resistance, andproved to be a portion, about 6 inches in length, of the lower HERNIA INTO THE INTERSIGMOID FOSSA 121 end of the ileum. It was moderately congested, and wasmarked at each end by a slight constriction. The opening in the peritoneum (see Fig. 34/) was oval,and its long diameter measured h inch. It was situatedclose to the left side of the sigmoid flexure, its lower marginbeing from i inch to i^ inches above and to the outer sideof the sacro-iliac synchondrosis, and i inch from the dissecting up the peritoneum from the subjacent muscles,. Fig. 34.—Mr. Eves Case of Intersigmoid Hernia. the opening was found to lead into a sac of peritoneum havingvery thin walls, which were attached to, or continuous with,the margins of the opening. The sac was pyriform, measured3 inches in its long diameter, and extended upwards andbackwards beneath the large intestine. Its posterior surface,in contact with the iliacus and lumbar muscles, was easilydissected from its connections; but its anterior surface wasso closely connected with the peritoneum and posteriorsurface of the large bowel that its continuity in parts couldnot be established. THE INTERSIGMOID FOSSA The sigmoid flexure was nearly surrounded by peritoneum,but had not a distinct mesentery, the two layers of peritoneumreflected from it being nowhere in contact. Above the open-ing of the hernia the flexure was bound down to the iliacfossa by three bands of thickened peritoneum. The much-distended caecum (a) occupied a position immediately to theri
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