Buffalo medical and surgical journal . or the neck continues to be near the internal ring, while thefundus may deviate towards the navel, pelvis, or the iliac parietal layer of the peritoneum must follow the neck of thesac so that it covers the whole sac like a funnel, when the neckis found torn loose and reduced high up. There is then a doublecover of peritoneum. Reduction en bloc is found both in smalland recent, and in old and large ruptures. Both inguinal andfemoral hernias may be reduced en bloc. 248 REDUCTION EN MASSE. The connective tissue around the sac seems to be stretchedm
Buffalo medical and surgical journal . or the neck continues to be near the internal ring, while thefundus may deviate towards the navel, pelvis, or the iliac parietal layer of the peritoneum must follow the neck of thesac so that it covers the whole sac like a funnel, when the neckis found torn loose and reduced high up. There is then a doublecover of peritoneum. Reduction en bloc is found both in smalland recent, and in old and large ruptures. Both inguinal andfemoral hernias may be reduced en bloc. 248 REDUCTION EN MASSE. The connective tissue around the sac seems to be stretchedmore than torn, as suggilations are not generally found. On theother hand, the incision does not fall in the scrotum, but overthe inguinal canal, which accounts for the authors failure tomention whether, as a general rule, the sac is torn loose and,therefore, a large bleeding cavity found in the scrotum or not. INTERSTITIAL HERNIA*Peritoneum. Internal ring. Peritoneum. Reduction en bloc without change of position of Reduction en bloc with the neck layer of peritoneum. In the second form, found only in inguinal hernia, the contentsof the hernia are by taxis reduced into a cavity formed by dila-tation of the inguinal canal. The sac itself is not dislodged,and the result is, therefore, not a reduction en bloc, but simply areductio spuria. In the third form, which is only found in femoral hernia, theprotrusion is dislodged laterally, but not reduced into the abdomi-nal cavity. On account of the shortness of the femoral canal » From Billroth & Pitha. REDUCTION EN MASSE. an interstitial reduction cannot occur, and the hernia is foundbetween the adductor longus and pectineus muscles. It is onlypossible in very fat patients. The fascia covering these musclesis ruptured by the taxis. One other form, mentioned by different authors, deservesnotice. By very violent taxis the sac may rupture, and thecoil may be reduced through the tear (and become strangu
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