64 SPRING-TIME SURGERY 



through the internal ring. Where the mass is so 

 large that there is difficulty and danger in pulling 

 it through the ring by traction on the cord alone, 

 then an assistant working through the rectum can 

 be of great assistance. He can force the testicle 

 through the ring in a manner that is much safer 

 than that of pulling it through and much larger 

 testicles can be removed safely by such means 

 than can be removed by pulling alone. 



Laparotomy May Be Necessary.— If the ex- 

 amination or repeated trials demonstrates the 

 fact that the testicle is too large to be safely re- 

 moved through the inguinal canal and its size can- 

 not be reduced by tapping or other means, then 

 there is but one thing to do. Discontinue the at- 

 tempts at removal, dress the wound, allow the 

 patient to rise, and wait a couple of weeks until 

 the inguinal wound is healed and then take the 

 testicle out through a laparotomy opening in the 

 upper flank. One might argue at this point that 

 a rectal exploration preceding the attempted oper- 

 ation would have made unnecessary the exposure 

 of the patient to the dangers attending the abdo- 

 minal exploration, but this is not true. I have yet 



