558 HERNIA 



adjacent tissues, if necessary, carefully so as to avoid injuring 

 the bowel. Return the contents to the abdominal cavity. 

 Remove a small portion of the hernial ring on either side 

 making a fresh wound surface to facilitate union of the 

 parts. Suture the wound and apply after-treatment as in 

 laparotomy (see Laparotomy). 



Ventral Hernia.— Definition.— Ventral hernia is a term 

 applied to a subcutaneous rupture of the abdominal muscles 

 which permits the abdominal contents to pass through. 

 This may occur at any point in the abdominal walls. The 

 hernial sac consists of the peritoneum, subcutaneous tissue 

 and the skin in the majority of cases. Sometimes the peri- 

 toneum is also ruptured allowing the contents to lie immedi- 

 ately under the skin. 



Etiology. —The cause of ventral hernia is usually traumatic, 

 or intra-abdominal pressure. In some instances when 

 incomplete union of the abdominal muscles takes place 

 following surgical operations, a hernia will develop. 



Symptoms.— The sudden development of an enlargement 

 appearing at some point in the abdominal wall. The size of 

 the hernia will depend upon the extent of the rent in the 

 abdominal muscles. Palpation of the enlargement will 

 reveal a soft, fluctuating or elastic mass which can be reduced 

 in most cases except when strangulated. When reduction is 

 brought about the opening through the abdominal muscles 

 can be easily determined and the margins of the hernial ring 

 felt. Changing the position of the patient will bring about 

 reduction except when adhesions are present or. the parts 

 strangulated. Unless the hernia is very recent or strangu- 

 lated, there will be no inflammation nor pain present on 

 manipulation. It is necessary to differentiate recent hernia 

 from abscess. This can be done by careful palpation or by 

 explorative operation. Some difficulty will be experienced 

 in distinguishing between incarcerated hernia and tumors. 

 However, the consistency, location and an explorative opera- 

 tion if necessary, will serve to make the , distinction. A 

 strangulated ventral hernia will be characterized by symp- 

 toms of inflammation, doughy consistency, pain on palpation 

 and the general reaction of the patient. 



