Strangulated Right Inguinal Hernia. (Richardson.)
The sac has been opened and its edges are drawn apart by means of forceps. The inguinal canal and spermatic cord have been dissected.
Taxis.
—The principal danger in connection with taxis is that of doing harm to the occluded bowel by rough manipulation. The method includes a coaxing pressure in the proper direction, with more or less compression of the external mass, the effort being to gently persuade it back into the abdominal cavity. In this effort the temptation, especially among the inexperienced, is to use too much force, by which extravasation is produced, exudate increased, and the local condition in every way made worse. That which is possible during the first hour after strangulation has occurred may be impossible a little later, when edema and exudate have distorted the parts or cemented them together. The effort should not be prolonged, but rather very brief, and if after a very few moments no gain be made it should be discontinued.
Reduction “en bloc” is an unusual but ever-present danger. It implies forcing back the peritoneal sac as well as its contained intestine unreduced, so that while the external tumor is dissipated the actual condition of strangulation is not influenced. Its effect would be in no way to diminish the danger of the condition, but rather to more seriously menace the patient, under the supposition that reduction had been accomplished satisfactorily.
Two or three axioms in the treatment of strangulated hernia are imperative:
Very little time, if any, should be wasted in manipulation or taxis.
Taxis failing or there remaining any suspicion of reduction en bloc, open operation is imperative.
The time to operate is just after the diagnosis has been made and the condition recognized. Every hour of delay increases danger of obstruction and of gangrene.
Operations for strangulated hernia should thus always be done early and before much exudate or local disturbance has occurred, as when thus performed they may be combined with measures for radical cure, which are hardly to be thought of when infection has occurred. (See [Plate LIV].)