On retro-peritoneal hernia : being the 'Arris and Gale' lectures on the 'The anatomy and surgery of the peritoneal fossae' : delivered at the Royal College of Surgeons of England in 1897 / by B.G.A. Moynihan.

  • Moynihan, Berkeley Moynihan, Baron, 1865-1936.
Date:
1906
Catalogue details

Licence: Public Domain Mark

Credit: On retro-peritoneal hernia : being the 'Arris and Gale' lectures on the 'The anatomy and surgery of the peritoneal fossae' : delivered at the Royal College of Surgeons of England in 1897 / by B.G.A. Moynihan. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    a good example of how a case should not be recorded. No mention is made of the side, left or right, of the strangled segment of gut. We can but infer from the context that the left side is meant. If so, it is more than difficult to understand Jonnesco's reasons for including the case in his list of retro-colic herniae. The case bears, apparently, a fairly close resemblance to that of Fages already described. Case of Furst.1—A tailor, aged sixty-one. The body was examined in the dissecting-room. A very accurate and detailed report is given. On opening the abdomen, the caecum was found to be below the umbilicus. The right hypochondriac and lumbar and a portion of the umbilical regions were occupied by a large peritoneal sac, the orifice of which measured in its largest diameter 12 centimetres, and looked downwards and a little forward and to the right. About two-thirds of the small intestine lay in the sac, the entering limb being the first part of the jejunum immediately beyond the flexura duodeno-jejunalis. The caecum and ascending colon were on the inner wall of the sac, the rest of the large intestine being pushed well over to the left. Many diverse opinions have been expressed about this case. Furst considered that the sac was the result of an abnormal process occurring during the development of the peritoneum. Jonnesco attempts a similar explanation, but is in ignorance of the views of Toldt as to the fusion process in the normal peritoneal evolution. Brosike, regretting the lack of a detailed description of the duodenum and jejunum, concludes that the first part of the jejunum was adherent in a manner similar to that found by him when the recessus para-jejunalis is present. His argument attempts to show that the hernia has occurred into this fossa, and has developed in the irregular manner figured by Furst, on account of two reasons—firstly a free common mesentery for the caecum and ascending colon, and secondly an unusually extended ' wandering' of the orifice of the mouth of the sac. This 1 Nordiskt Medici?iiskt Archiv,' redigeradt af Axel Key, sextonde Bandet, tredje Haftet, Stockholm, 1884. 8—2