cryptorchidectomy 271 



Fifth Step.— Ablating the Testicle.— The ablation is ef- 

 fected in the usual manner, with the emasculator or ecraseur. 

 Sixth Step. — Preventing Prolapsus of the Intestines. — 



This part of the operation must never be entirely ignored; 

 sometimes it is a very essential feature of the successful pro- 

 cedure. When the perforation is a small one the only pre- 

 caution to take is that of keeping a firm pressure with the 

 hand over the perforation as long as the legs are widely 

 parted by the ropes,' as sudden tenesmus may send a loop of 

 intestines through it unnoticed. The operator should keep 

 the hand upon the region while the assistant releases the 

 patient from the harness. When the legs close together 

 after'untying there is little danger of the accident occurring. 



When the perforation is a large one the only safe prac- 

 tice is that of packing the inguinal canal with sterilized 

 gauze and retaining it with a few stitches across the incision. 

 The packing, in order to be effectual, must be voluminous 

 enough at the level of the orifice to actually support the in- 

 testines if any should rest upon it. (See Sequelae, page 272). 



MODIFICATIONS.— These technics do no.t meet every 

 contingency, as they do not answer for several more or less 

 rare cryptorchidic conditions. The most common one re- 

 quiring a modification of these descriptions is the one we 

 arbitrarily designate as "infra-inguinal" and which .Farmer 

 Miles calls No. 4. This testicle is trapped in the internal 

 abdominal ring. The epididymis has passed through the 

 internal abdominal ring, carrying with it the tunica vaginalis, 

 but the body of the testicle is within the abdomen, resting 

 upon the ring. Sometimes -the epididymis stretches down 

 at great length, almost descending as far as the scrotum, 

 and when found during the operation it may be mistaken 

 for the testicle until exposed by cutting the tunica vaginalis. 

 This form of cryptorchidism is met by tracing the epididymis 

 upward as far as the ring and then making a perforation one- 

 half inch or so anterior to it, large enough to admit the 

 index finger, with which the testicle is easily hooked out. 



In this same variety of cryptorchidism the testicle may 

 be found to have undergone cystic degeneration, in which 

 instance it is found fluctuant instead of possessing its char- 

 acteristic consistency. Sometimes the "cyst is so large that 

 its contents must first be evacuated before it can be brought 

 through the perforation. This may be done with a trocar 

 and canula, or else by simply rupturing the wall with' the 

 finger and allow the fluid contents to flood into the peritoneal 

 cavity. The latter course is quite as successful and much 



