File:Modern surgery, general and operative (1919) (14597603978).jpg

Identifier: modernsurgerygen1919daco (find matches)
Title: Modern surgery, general and operative
Year: 1919 (1910s)
Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933
Subjects: Surgery, Operative
Publisher: Philadelphia : Saunders
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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tissue, andperitoneum. Congenital inguinal hernia is aportion of bowel within an unclosedvaginal process. The bowel in congenital hernia has one layer of peritoneumin front of it. The testicle is posterior and below (Fig. 848, b). Always re-member that bowel may not enter the sac of a congenital hernia for severalmonths or longer after birth. Congenital hernia conceals or buries the testicle;acquired hernia does not. If a vaginal process, open above and closed below,contains a hernia, the condition is called hernia into the funicular process (Fig.848, c). If the funicular process is closed at the abdominal end, but not below, ahernia in a special sac may descend back of the vaginal tunic. This condi-tion is known as infantile hernia. In infantile hernia there are three layersof peritoneum in front of the bowel—the two layers of the vaginal tunic andthe one layer of sac. The testicle is in front (Fig. 848, d). If the tunica vaginalis is closed above and not below, and a hernia pushes
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Fig. 848.—a, Scrotal hernia; b, congenitalhernia; c, funicular hernia; d, infantile hernia;e, encysted hernia. Varieties of Hernia 1299 down the vaginal process and causes it to double on itself, the condition isknown as encysted infantile hernia (Fig. 848, e). In femoral hernia the contents descend along the femoral canal to the innerside of the vein, and the neck of the sac is at the femoral ring. The neck ofa femoral rupture is always external to the pubic spine; the neck of an inguinalrupture is always internal to the pubic spine. Femoral hernia contains omen-tum, but seldom intestine, except in strangulated cases. It used to be saidthat femoral hernia was never congenital. Russell and Coley show thatit may be (see page 1273). Thirty per cent, of hernise in women are femoral.The broad female pelvis means a large femoral ring. The coverings of a femoralhernia are skin, superficial fascia, cribriform fascia, crural sheath, septum crurale,subserous tissue, and peritoneum. Occasiona

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