Cases of hernia of the bladder met with during operations for inguinal and femoral hernia / by Christian Fenger.

  • Fenger, Christian, 1840-1902.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Cases of hernia of the bladder met with during operations for inguinal and femoral hernia / by Christian Fenger. 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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    laparo-herniotomy, as a dangerous addition to the operation, and his argument is incomplete when it is remembered that in all operations for hernia we do not hesitate to divide the ring sufficiently for exploration and operation to secure a normal condition of the reduced contents of the hernia, division of ad- herent omentum or loosening of intestinal adhesions to the intra-peritoneal portion of the ring. Digital exploration through a wide or divided ring, as prac- tised by Walther, will also help in the diagnosis of hernia of the bladder when it is seen that a mass or sac found in the hernia leads down behind the symphysis toward the bladder, but is, of course, less positive than when combined with exami- nation with the sound. But even examination with the sound has sometimes proved negative, as in Postempski’s^^ case, in which he recognized the muscular fibres of the bladder, intro- duced a sound, found that he could not pass it up into the suspected mass, concluded that his suspicion was unfounded, and opened into the bladder. In large vesical hernias with typical symptoms, the diagnosis is, of course, not very difficult, but such cases are comparatively rare, as in sixty-five operations collected by Siegel,^^ in which vesical hernia was found, diagnosis prior to operation was made in only 12 cases. The bladder has been frequently wounded during the radical operation for hernia. Lejars,^^ in 1893, collected 20 cases, in 15 of which the wound in the bladder was immediately recog- nized in the remaining 5 cases the wound of the bladder was not recognized until later. Besides the cases of Israel, Berger, Guelliot, Aue, and Jungengel, cited by Lejars, there are on record the cases of Leszinsky,^“ and Habs,^ arid Reverdin^^ found on microscopic examination of the sac by Zahn that the sac was partly bladder. In these cases the diagnosis is either made when the urine shows in the dressings or when tenesmus and hsematuria occur. It is, of course extremely difficult to make the diagnosis in cases of vesical hernia with no sac. Thus Aue, in a case of femoral hernia, found no peritoneal covering, and supposed the