Stra ngulated Hern ia 227 



Failing in these efforts, herniotomy should be performed 

 with the least possible delay. After thorough disinfection 

 of the region, proper sterilization of hands and instruments, 

 and covering the adjacent parts, including the hind feet and 

 legs, with aseptic or antiseptic towels or napkins, the scro- 

 tum is to be freely and cautiously incised down to the in- 

 carcerated intestine, after which the carefully disinfected 

 and moistened index finger is to be passed up along the an- 

 terior side of the herniated bowel to the point of incarcera- 

 tion in the internal ring. Using the finger as a guide, a 

 herniotome, probe-pointed bistoury, scalpel, or such other 

 instrument as the exigencies of the situation demand, is in- 

 troduced through the ring at its antero-external angle and 

 the tissues are sufficiently divided, forward and outward, to 

 permit the incarcerated intestine to return. Sterile or anti- 

 septic gauze is then introduced into the wound and packed 

 closely against the internal ring in a manner to avoid all 

 danger of a recurrence of the hernia, and the scrotal wound 

 is closed by sutures. The tampon may be omitted and deep 

 sutures taken in the internal ring, closing it against future 

 hernia. 



Twenty-four to forty-eight hours later the antiseptic 

 gauze may be removed, and the wound disinfected, closed, 

 and thereafter left undisturbed or handled according to in- 

 dications. If the strangulation of the intestine has already 

 led to the necrosis of the incarcerated loop, resection of the 

 intestine should be promptly performed. When herniotomy 

 is performed, if there is doubt concerning the viability of the 

 incarcerated loop, after the inguinal ring has been freely 

 dilated, additional intestine may be drawn out and the parts 

 carefully examined. The intestine should be kept moist with 

 physiologic salt solution. The operation of resection, be- 

 longing to surgery, need not be described here. The prog- 

 nosis in herniotomy is good in properly selected cases. 



