. On retro-peritoneal hernia . eso-colon, or both. 3. The hernial sac consists of a single layer of its expansion away from the spine the sac will rest behindon the various structures placed on the posterior abdominalwall. In front of it will be the posterior parietal peritoneum,more or less closely united to the sac wall. It results thenin the hernial contents having two layers of peritoneum infront of them and one layer of peritoneum behind them. The Neck of the Sac.—The orifice of the sac is situated, asa general rule, at the back of the hernia, in close approxima- THE NECK OF
. On retro-peritoneal hernia . eso-colon, or both. 3. The hernial sac consists of a single layer of its expansion away from the spine the sac will rest behindon the various structures placed on the posterior abdominalwall. In front of it will be the posterior parietal peritoneum,more or less closely united to the sac wall. It results thenin the hernial contents having two layers of peritoneum infront of them and one layer of peritoneum behind them. The Neck of the Sac.—The orifice of the sac is situated, asa general rule, at the back of the hernia, in close approxima- THE NECK OF THE SAC 47 tion to the lumbar vertebrae. Its exact relationship to thebulk of the hernia depends almost entirely upon the quantityof bowel contained therein. In the smaller hernise it issituated to the right of the hernial mass, and looks slightlyto the front. As the mass of bowel contained within thesac increases in quantity, the relative position of the orificegradually becomes altered, becoming first right and eventually. Fig. 13.—Treitzs Case of Left Duodenal Hernia. right and posterior, and wholly posterior. In a large herniait is necessary, in order to expose the neck of the sac, todrag the whole mass well over to the left side. The orificeis then seen close down to the third lumbar vertebra(Fig. 13). In the smaller hernijc the transverse measure-ment of the orifice generally exceeds the vertical, but withthe increase in bulk the longitudinal diameter becomes more THE DUODENAL FOLDS AND FOSS^ and more elongated, until eventually it may extend quitedown into the neighbourhood of the caecum. It is, how-ever, not the largest hernige which have always the largestorifices of entrance. Some very large herniae have beenseen where the neck of the sac was quite small, and vice-vcrsd. In many of the reported cases the size of the hernialorifice has been distinctly mentioned. Treitz records twowhere the aperture admitted in one case two, in the otherthree, fingers. Peacocks cas
Size: 1360px × 1837px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookauthormoynihanberkeleymoyni, bookcentury1800, bookdecade1890
