Case of obturator hernia of the ovary / by J. Dunlop Lickley.

  • Lickley, James Dunlop.
Date:
[1902]
Catalogue details

Licence: In copyright

Credit: Case of obturator hernia of the ovary / by J. Dunlop Lickley. 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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    hypogastric artery. On tlie inner boundary of the mouth of the sac was the side of tlie bladder, which, in tliis subject, was enlarged and extended in the collapsed state up to the edge of the obturator ring. This extension was also noted on the opposite side, and was, tlierefore, not the result of traction of the hernia. The wall of the hernial sac consisted of two distinct layers—a layer of peritoneum within, and a layer of pelvic fascia without. Between these two layers was a considerable amount of fat, the fat of the subperitoneal tissue, which reached its maximum at the bottom of the sac, forming tliere a well-defined pad of fat about 1 cm. in diameter. There were a few associated pathological conditions in the case which are worthy of notice. The ovary, which was lodged in the hernial sac, had a very smooth covering, on which no scars were visible. It contained numerous small cysts, a condition which existed also in the left ovary. Adhesive bands bound down the left ovary, and a well- marked adventitious band was found, stretching from the uterus to the rectum, across the pouch of Douglas. The round ovarian ligament of the right side was much longer than that of the left, the measurements being—right, 8'5 cm., and left, 1 cm. The right Fallopian tube was corre- spondingly elongated. The body of the uterus had been deflected to the right side, the cervix lying over to the left. As remote patliological conditions may be mentioned (1) a constriction of the vagina, 3'7 cm. from the orifice, associated with (2) an adhesive obliteration of the external os; and (3) a distinct small hernial sac in the left crural canal. 1. Apart from the rarity of this form of obturator hernia, the chief interest in this case is to be found in the arrangement of the fascia forming the sac of the hernia. As quoted by Fredet,^ Picque and Poirier, and following them Berger, have described the sac of an obturator hernia as formed merely of peritoneum. According to these writers, the obturator ring is uncovered by fascia, the pelvic fascia recognised by them stopping short, when followed upwards from the surface of the obturator internus muscle, in a distinct thickened band which forms the lower boundary of the foramen, a view which has been adopted in recent text-books.^ I have examined several normal pelves with a view to this point, and 1 Fredet, Reoue de Ckirurgie, 1901, xxiii. Testiit, Traite d'Anatomic fhimaine, 1897 ; Poirier, 7'raiti d^Anatomic Ilumaine, 1896 ; Quain's Anatomy, 1892, vol. ii, part 2.