On prevesical hernia : with the relation of a case in which subacute strangulation occurred / by G.H. Makins.

  • Makins, George Henry, 1853-1933.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: On prevesical hernia : with the relation of a case in which subacute strangulation occurred / by G.H. Makins. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    lias quoted, points come out which support what he has con- tended. There are several distinct forms of hernia, at any rate as regards their origin, to which the term pre- or perivesical may appropriately be used. In the first place, there are nume- rous cases of reduction en masse, one of which I had an oppor- tunity of dissecting. In that case the sac lay against the bladder, and contained still strangulated gut. Secondly, there are cases of preperitoneal hernia where there is really a double sac, one part being in the inguinal canal and another down against the bladder or in its vicinity. I would urge that the term pre- or perivesical is preferable to that of inguino- properitoneal, which jKronlein suggested, and which German writers have so generally adopted. It implies that the hernia is always originally an inguinal one, whereas it has sometimes been of the femoi’al variety, and further it says nothing as to the relation of the internal parts of the sac to the bladder. My case was that of a man healthy, except that he had a right inguinal hernia. This had given him little trouble, and for seven weeks had not come down into the scrotum. I lay stress upon this fact to show that no direct pressure by a truss or vigorous taxis had anything to do with the symptoms for which he came under my care. Without any obvious cause he was seized with pain in the lower part of the abdomen, followed by sickness ; the latter soon ceased but the pain persisted, and he was admitted to the London Hospital. I found on passiug my finger up the right inguinal canal that there was distinct fulness or tension to the inner side thereof. This fulness and the man’s anxious expression, together with the pain, were really the only symptoms upon which to form a diagnosis. I urged the man, however, to allow me to perform abdominal sectiou, and this was done within twenty-four hours of the onset of symptoms. Through a median incision I at once made out the existence of a ring immediately to the right of the bladder leading down into a pouch, in which a single loop of small intestine was tightly strangulated. It was easy to notch this ring and draw out the hernia from above. I may note that the canal was quite clear and the vermiform appendix lay just at the orifice of the neck of the sac. Having reduced the intestine, I sewed up the neck of this pouch with catgut to prevent re-descent of the hernia. I did not feel justified in dissecting out the peritoneal pouch, though this might have been possible. He recovered without a bad symptom. I believe this case is an instance of what the author would term true prevesical hernia, inasmuch as there was no pouch leading into the inguinal canal at the same time as the existing prevesical sac. It is certainly of very rare occurrence, for on hunting up the recoi'ds at the London Hospital for the last fifteen years I could find no other similar case. I would venture to dissent a