Incision about five inches in length was made parallel to Poupart's ligament and immediately over the inguinal canal, passing through the skin and subcutaneous fat. The external ring having been exposed a grooved director was passed into same, passing under the aponeurosis of the external oblique muscle; fibers of same were split, using the director as a protective guide. The sac was exposed and carefully dissected free from its surrounding tissues, and upon examination was found to be continuous with the covering of the testacle (giving the appearance of a congenital hernia). The sac was next opened and found to contain small intestines and a Meckel's diverticulum. Following this the intestines were replaced in the abdominal cavity. Digital examination through the internal ring showed the bladder to be adherent to the peritoneum at the margin and toward the median line. The sac was tied close to the internal ring, cut free. The distal portions of the sac were drawn upward, bringing the testacle into view; sac was cut close to same and sutured so as to enclose the greater part of it.
The margins of the internal oblique and transversalis muscles were sutured to Poupart's ligament by a mattress suture. The aponeurosis of the external oblique was re-established into normal position by suturing, and the skin closed by subcutaneous silver wire suture silk having been used for all other sutures.
Sterile dressings were then applied and cardboard splints to keep limb immobile. Then bandaged with crenolin. The patient left the operating room at 1 P. M. in good condition.
Notes of Interest—
That a hernia, apparently congenital, should not have made an earlier appearance.
The presence of a Meckel's diverticulum in the sac, this being the condition that gives rise to a true Richter's hernia.
That a hernia of so large proportion should have caused so little trouble to the patient.
Patient recovered in very short time, leaving the hospital in good condition.
THE TEACHING OF THE SPECIALTIES.
By Hiram Woods, M. D.