PERINEAL HERNIA 563 



Treatment.— It is possible to reduce femoral hernia by the 

 usual hernia operation but care should be taken to avoid 

 the large vessels in the immediate vicinity. 



Diaphragmatic Hernia.— Definition.— A hernia taking place 

 through the diaphragm. It may be either congenital or 

 acquired. This hernia is characterized by the passage of a 

 portion of the abdominal viscera into the thoracic cavity 

 either with or without the peritoneum. 



Etiology. —Most cases of acquired diaphragmatic hernia 

 occur as a result of violence in which the diaphragm ruptures 

 allowing abdominal viscera to pass through the rent. Stran- 

 gulation is rare. 



Symptoms.— No symptoms are observed in most cases of 

 congenital diaphragmatic hernia. In the acquired form the 

 symptoms come on suddenly and consist of severe dyspnea, 

 restlessness, pain, etc. The patient as a rule does not live 

 but a short time. A few cases have been observed where the 

 patients lived for several months showing dyspnea and 

 marked circulatory disturbance. A diagnosis is in most cases 

 difficult. 



Treatment.— No treatment can be given. 



Perineal Hernia.— Definition. — A hernia appearing in both 

 males and females and characterized by an enlargement on 

 one or both sides of the anus. 



Etiology. — The perineal tissue is easily ruptured or torn 

 allowing some of the abdominal organs or omentum to pro- 

 trude at the sides of the rectum. Perineal hernia is often 

 observed in trick dogs which are required to walk a great 

 deal on their hind legs. The unnatural position and the 

 pressure of the abdominal organs no doubt lead to rupture 

 of the perineal tissue. It may also result from strain from 

 coprostasis, prostatic enlargement, etc. Strangulation is 

 rare in this form of hernia. In some cases torsion of the 

 bladder accompanies it. 



Symptoms.— This hernia is recognized as an enlargement 

 appearing at one or both sides of the rectum. The majority 

 of cases are unilateral. The anus is pushed to one side and 

 often there is difficulty in defecation. In the female the 

 enlargement is usually slightly lower than in the male. 



