. Abdominal hernia : its diagnosis and treatment. twithstandingthe fact that careful truss-fitting had been carried out. It isbest, therefore, to consider and treat these as cases of irreduciblehernia. {b) Atlhesions of omentum to the sac wall are very com-mon in inguinal hernia, but it is rather rare to find the boweladherent. This is doubtless due t(T the sluggish character ofthe former, and the ])eristaltic action of the latter. In very oldand large herniae, the normal motion of the bowel may be lost,and then adhesions form. Such cases are subject to the mostobstinate constipation, terminat
. Abdominal hernia : its diagnosis and treatment. twithstandingthe fact that careful truss-fitting had been carried out. It isbest, therefore, to consider and treat these as cases of irreduciblehernia. {b) Atlhesions of omentum to the sac wall are very com-mon in inguinal hernia, but it is rather rare to find the boweladherent. This is doubtless due t(T the sluggish character ofthe former, and the ])eristaltic action of the latter. In very oldand large herniae, the normal motion of the bowel may be lost,and then adhesions form. Such cases are subject to the mostobstinate constipation, terminating in true intestinal obstruc-tion, and this is (|uite liable to cause death from paralysis of thebowel, even if operation is done. In these hernire, bands of 82 DIAGNOSIS OF INGUINAL HERNIA. 83 connective tissue may also be found running in various direc-tions through the sac, effectually preventing the return of itscontents. (c) A very common cause of the irreducibility of herniais the hypertrophy and growth of protruding omentum. It Fig. Left scrotal oblique inguinal liertiia containing large mass of irreducible omentum. becomes hard, nodular, and of such size that it is impossible topass it back through the canal even though no adhesions arepresent. It rarely ha])i)ens that these masses, of protrudingoiuentum, plug up the canal so that the intestine cannot pro-trude. On the contrary, such cases are always attended byincreased dangers of strangulation. 84 ABDOMINAL HERNIA. Fig. 39 shows an irreducible hernia where a large massof hypertrophied omentum was found at time of 40 shows an even larger hernia when tlie contents weremostly intestine and wholly reducible. Methods of Examination.—Inspection shoukl lie with thepatient standing, and if a truss or support is being worn, it Fig. 40.
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