556 HERNIA 



old cases connective tissue elements form around the margins 

 which results in a distinct, firm ring. Palpation of a hernia 

 will often reveal a well defined, firm enlargement which will 

 serve to differentiate recent from long standing cases. 



(c) The contents of a hernia are quite varied and will 

 depend somewhat on its location. In most cases they consist 

 of a portion of bowel, or omentum, or both. In a smaller 

 number a portion of one of the other abdominal organs is 

 present, such as the liver, stomach, spleen, uterus or bladder. 

 When the contents fluctuate on palpation it may be due to the 

 fluid content in the loop of bowel, or to serum which accumu- 

 lates from a venous stagnation of the imprisoned contents. 



From a practical standpoint it is important to classify 

 hernias into: (a) Reducible, and (6) irreducible. 



(a) Reducible hernias are those in which the contents can 

 be readily replaced in the abdominal cavity. This may be 

 done by manipulation, or is often accomplished by changing 

 the position of the patient. Such hernias present certain 

 characteristic symptoms: They are enlargements, usually 

 appearing on some portion of the abdominal wall, non-inflam- 

 matory (usually), easily replaced in the cavity, and the ring 

 readily distinguished. It is possible in many cases to 

 determine the character of the hernial contents by palpation. 

 Adhesions will take place in some cases between the hernial 

 sac and its contents which will interfere with complete reduc- 

 tion of the enlargement. In this case, as soon as pressure is 

 removed from the outside, the hernial contents will again 

 reappear in the sac. Practically all reducible hernias return 

 unless outside pressure is maintained. 



(6) Irreducible hernias are those which cannot be returned 

 by manipulation to the abdominal cavity. This condition 

 may be brought about by adhesions between the different 

 parts of the hernia, by swelling around the hernial ring, or by 

 strangulation with subsequent swelling of the hernial con- 

 tents. When a loop of bowel is present in the hernial sac- 

 strangulation frequently occurs from fecal matter accumu- 

 lating and distending the prolapsed bowel. It is very impor- 

 tant to distinguish between strangulated and non-strangu- 

 lated hernias. The differentiation is made very definitely 



