Remarks on the modes of proceeding in regard to the hernial sac in the operation for strangulated hernia / by William Pirrie.

  • Pirrie, William, 1807-1882.
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the modes of proceeding in regard to the hernial sac in the operation for strangulated hernia / by William Pirrie. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    a limited extent, and in hernias of moderate size. Most of these conditions, however, are principally met with in cases of large and old heniiai; and, on account of the risk of injuring the nitestme m attempts at reduction, as well as that of inducing dangerous niflam- mation by much handling of the intestine, and the difficulty of mam- taining the parts reduced, even should reduction be possible, the majority of surgeons seem now disposed to follow the advice of Sir Astley Cooper regarding such cases. His practice was to divide the stricture, which fortunately in such cases is, for the most part, ex- ternal to the sac, and to leave the latter unopened, and the hernia luireduced. The stricture being divided, the principal cause of danger is removed. The coverings of the hernia should be replaced, and proper means taken for promoting the healing of the wound. Thirdly, There are certain states in which it would be extremely improper to attempt reduction; namely, when the hernia is gangre- nous, or when the intestine has given way from inflammation having gone on to gangrene, or when it has been torn, or accidentally wounded in the operation. The two last-mentioned conditions can only result from unskilftilness in the mode of procedure; but, should they exist, the hernia ought not to be returned. When the intestine presents such an appearance as to render it doubtful whether its return may be followed by foscal extravasation, the surgeon should content himself with carefiilly dividing the stricture. In all cases in which the intestine is gangrenous, or not entire from whatever cause, it ought to be allowed to remain, so that the faeces passing off by the wound may form an abnormal anus, and extravasation into the abdomen be thereby prevented. When omentum forms the hernia, and it is gangrenous, the gangrenous portion may be removed, and the remaining part returned to the abdominal aspect of the mouth of the hernial sac. The practice of removing a portion of omentum, when fr'om growth it renders a hernia irreducible after division of the stricture, is a proceeding which, in some cases, may be adopted with advantage. For cases belonging to this class, extra- peritoneal di\dsion is of course quite unsuitable. These remarks, it is to be hoped, will be sufficient to point out the proper mode of procedure when the hernia is sound, and reducible after division of the stricture; when it is irreducible after such division—and when it is in any of the various conditions in which reduction would be dangerous and improper; and also to show, that to follow one method indiscriminately in all cases would be unwise; that intra or extra peritoneal division should be adopted according to the particular circumstances of the case; that in the majority of cases intra-peri- toneal division is not only the more suitable mode, but the only one which is safe, or by which any good can be effected; and that the cases in which extra-peritoneal division is suitable are those of very short standing, where there is no reason to apprehend the existence of adhesions, or of an unsound condition of the hernia ; and in cases