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Rupture - Hernia.The chief forms of rupture are those in which the bowel escapes into the upper part of the thigh, or through an opening called the inguinal canal, or at the navel. We may, therefore, speak of rupture as follows : 1. Inguinal hernia. 2. Femoral hernia. 3. Umbilical hernia. The inguinal canal is an opening or channel which passes obliquely through the abdominal wall justabove the bone at the lower part of the front of the body. Before birth, this canal remains open in order to permit the passage of certain organs from the abdomen through the abdominal wall - a process quite natural to the development of the child. After this has been accomplished the canal diminishes in size, and is so firmly closed that in most individuals the contents of the abdomen never escape. The opening of this canal is, however, a weak point in the abdominal wall, and when a person violently compresses the contents of the abdomen, as is done during the evacuation of the bowels and during childbirth, the intestines are sometimes forced into and through this canal, and appear under the skin outside of the abdominal cavity. In other cases the inguinal canal is not closed as usually happens ; it remains open to such an extent that a fold of intestine is found in it, even at the birth of the child. This condition is called congenital hernia. There is also another canal which leads from the abdomen a short distance downward into the thigh, alongside of the large artery and vein which passes from the body into the lower limb. This canal is sometimes forced open by pressure of the abdominal contents, a loop of intestine escaping into it and forming a slight prominence under the skin at the upper part of the thigh. In consequence of the greater breadth of the hips and pelvis in women, this variety - the femoral hernia - is more common in women than in men. Umbilical hernia occurs usually soon after birth, though it may also begin in more advanced life. It results from weakness of the abdominal wall at the point where the umbilical cord is attached in the fcetus. Surgeons divide all ruptures according to the condition of their contents into three classes : 1. Reducible hernias, those whose contents can be pushed back into the abdomen. 2. Irreducible hernias, whose contents cannot be returned into the abdominal cavity. 3. Strangulated hernias, that is, those which are constricted at some point so that the passage of their contents and the circulation of blood in them are obstructed. The most frequent form of rupture is the inguinal hernia, which occurs in males much oftener than females. It usually begins immediately after some violent strain or exercise. This strain may consist in lifting, jumping, etc. In some cases the patient feels a sharp pain and soon afterward notices a lump in the groin ; at other times there will be no especial symptoms to call attention to this part of the body ; the patient observes simply a gradual swelling in the groin or of the scrotum. When the rupture is fully developed there is a swelling in this part which may vary in size, being sometimes as large as a man's head ; it is usually somewhat tender and elastic, though easily compressible. There is no redness of the skin nor other sign of inflammation, the patient suffering no pain. If the hernia consists of one or more loops of intestine which have escaped through the inguinal canal, there may be some interference with the functions of the bowels ; the patient is often troubled with constipation and sometimes with attacks of colic and vomiting. In other cases the hernia does not contain the intestine itself, but consists merely of some of the layers of fat - technically called omentum - which cover the intestines. In this case the tumor is not so tense or elastic, and the rupture may cause the patient no other trouble than the mechanical annoyance caused by the swelling. There are certain signs whereby we can distinguish a rupture from other tumors which are present in the same part of the body. Thus a hernia varies in size with the position of the individual ; it is smaller when he lies down and larger when he stands erect. In many individuals the swelling disappears entirely during the night. By directing the patient to cough, and holding the hands upon the base of the tumor where it joins the body, we can feel a decided impulse transmitted to the fingers during the act of coughing. Many persons can reduce the hernia, that is push it back into the abdomen at will, though it usually reappears so soon as the fingers are removed. Irreducible hernia occasions several inconveniences. After taking a full meal the patient is often troubled with dragging pains in the abdomen and attacks of vomiting. It is in these cases, too, that colic and constipation so frequently occur. Treatment.-In treating a reducible hernia the usual plan and one which should be always tried, is the use of a truss. It is very important that the hernia should be attended to, since it is liable to cause serious trouble at any moment. In ordering a truss it is customary to take the circumference of the body at the hips, about midway between the bony prominence at the front of the hip and the large bony projection at the upper end of the thigh-bone. It is much better, however, to have the truss adjusted to the person by one accustomed to the work ; for a badly-fitting truss not only gives a great deal of annoyance, but is also somewhat dangerous, since it deludes the patient with a sense of security, and may induce him to make efforts and execute movements which will result in injury to the rupture. Several operations are practiced by surgeons for the radical cure of rupture. These are more or less successful, but cannot be relied upon always ; nor are they entirely devoid of danger. If a truss be applied while the patient is still a child or youth, a permanent cure is often effected, since the canal becomes gradually closed and strong enough to prevent the escape of the bowel from the abdominal cavity. It is highly important that the truss should be worn constantly ; it would be much better if the patient would wear it even in bed. By removing it for a few moments he frequently undoes the good that it has taken weeks to accomplish, since the intestine may be forced into the canal while the abdominal wall is unsupported by the truss. If some time must elapse before the patient can provide himself with a truss, a bandage should be applied which shall support the abdominal wall until the truss can be obtained. A small pad, made by folding soft flannel or cotton cloth, is placed over the opening through which the rupture appears. A bandage is then applied around the waist, and a second one is pinned to this in front, and is passed between the thighs and fastened to the bandage again behind. This second strip covers the pad, and holds it firmly in position. Several layers of bandage may be applied until sufficient protection is afforded. The truss must usually be worn for several years, and perhaps even during the entire life. The patient cannot be too careful in the matter, since he is constantly liable to an accident which may cost him his life. When the truss is obtained, the rupture sffould be returned to the abdominal cavity. To do this, the patient is placed upon his back on the bed, the foot of the bed being slightly elevated. The operator then exerts a gentle pressure upon the swelling from below upward, kneading the tumor meanwhile so as to facilitate the passage of the intestine into the abdominal cavity. No violence should ever be used in this manipulation. Strangulated Hernia. - A hernia is said to be strangulated when the intestine is grasped or constricted so tightly at some point as to prevent the passage of its contents along the bowel. Strangulation may occur in an old as well as in a recent hernia, Sometimes the patient is not aware that he has ever had a rupture until the symptoms to be presently described occur; in other instances the individual has suffered for a long while from hernia, and has perhaps become so accustomed to it that he neglects to take proper precautions in the use of a truss and in the avoidance of violent effort. Symptoms. - The first symptoms of which the patient complains are due to the obstruction of the bowels. This will be understood when it is remembered that a loop of the intestine is forced into the canal and doubled upon itself so as to make a knuckle-like protrusion. The result of this is that the contents of the intestine cannot pass through the constricted part. The first symptoms are, therefore, colicky pains, often accompanied by an accumulation of gas which distends the abdomen. The patient experiences a sense of tightness in the abdomen; he has a constant desire to evacuate the bowel, but his efforts are unavailing. After a few hours, vomiting occurs; the vomited matters are at first merely the contents of the stomach, but subsequently contain bile and even matters which can be recognized by their odor as the contents of the bowels. The patient becomes much prostrated ; the pulse is rapid and feeble, the skin pale, the countenance exhibits anxiety and distress. There soon ensues an inflammation at the .seat of the constriction. The abdomen becomes very tender and swollen. If no relief be obtained, the parts begin to mortify and the patient sinks into a condition of collapse which soon terminates fatally. Treatment. - If these symptoms occur, no time should be lost in securing the services of a surgeon ; for the patient's life depends upon speedy and skillful relief. Until his arrival, the following measures may be tried for the relief of the patient. The object of treatment is, of course, to restore the intestine to its proper position in the abdominal cavity. This can sometimes be accomplished by manipulation alone. The patient should lie upon a bed the foot of which is elevated. The knees are to be drawn up so as to relax the muscles. The bladder and rectum should be emptied by the patient himself if he is in a condition to accomplish it,. otherwise by the use of a catheter and by injections of warm water into the rectum. If there be anybody present who is competent to administer ether, the patient should be put under the influence of this drug; otherwise he should be engaged in conversation, so as to divert his attention from the manipulations which are to be performed. The operator then grasps the tumor with both hands and very gently compresses it. He should then attempt to pass the intestine up through the ring, which can be plainly felt with the finger, at the base of the tumor. Great care and gentleness must be exercised in this effort since unnecessary violence may cause serious injury. The manipulation should be continued for twenty or thirty minutes, unless the patient complain of extreme pain before the expiration of that time. The return of the bowel to the abdominal cavity will be indicated by a gurgling sound and sensation, the tumor at the same time disappearing. If this effort does not succeed, the patient should be placed in a hot bath (ioo degrees F). By this means the tissues are often relaxed so that the loop of intestine can be returned to the abdomen with considerable ease. If all these measures fail, the patient should take twenty or thirty drops of laudanum, and cold applications should be made to the swelling, A piece of ice, wrapped in flannel, may be bound over the skin. It is important to inspect the skin every twenty or thirty minutes, to see that it does not become too cold, a condition indicated by a ghastly whiteness ; for if the temperature be lowered too much, mortification of the part will ensue. It sometimes happens that, after the patient awakens from the sleep which is induced by the laudanum, another effort may be successful in reducing the hernia. Care should be taken to avoid the use of purgatives or cathartics ; these merely aggravate the patient's sufferings and render his condition more precarious. If all these measures fail, an operation must be performed. The friends should reconcile themselves to this idea at once, and not insist upon delay in the hope that the difficulty may be remedied spontaneously. For this is one of the conditions in which delay is not only dangerous but fatal; in fact, an operation should be performed just so soon as a faithful effort at reduction has proved unsuccessful. Strangulated hernia may occur either in the inguinal canal or at the upper part of the thigh in the femoral canal. In the latter case the symptoms are essentially the same as those just described, and the remedies needed are identical. A femoral hernia rarely attains a large size, and the chances for reducing it without operation are not so good as in the case of inguinal hernia. The symptoms of strangulated hernia should be borne in mind, and the possibility of this condition remembered whenever obstinate vomiting without any apparent cause occurs. For it sometimes happens that the loop of intestine which becomes strangulated is so small that it does not produce any appreciable tumor; it is only by close inspection that even the experienced eye and finger can detect a minute tumor. Cases have occurred in which patients have died of strangulated hernia without any suspicion existing in the minds of the friends or the physician as to the real nature of the difficulty, which was discovered only by a postmortem examination. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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