HERNIA. 



Hernial Rupture. 



By the word " hernia" we understand a protrusion of a certain 

 portion of the abdominal contents through a normal or abnormal 

 opening in its wall, and where the displaced jjortion is covered, 

 or partially covered, by the peritoneum. In the majority of cases 

 hernia appears under the external skin, although we may find it 

 in other parts, such as hernia of the diaphragm. There are several 

 different forms of hernia. 



We distinguish the following parts, in a hernia: first, the in- 

 testines or contents which protrude from the abdominal cavity; 

 second, the hernial pouch ; third, the envelope, or covering of the 

 rupture ; and, fourth, the entrance or constricted portion of the rup- 

 ture, or where the intestine passes through the abdominal "wall. 

 By " hernial pouch " we mean that part of the peritoneum which 

 is around the part protruding from the abdominal cavity, and we 

 distinguish it where it is near the constricted portion by forming 

 at the neck. The portion which lies in the hernial sac is the body 

 and lower portion. The hernial pouch is absent in some cases — 

 for instance, in a hernia which has occurred in a traumatic way, 

 as a result of some injury, and the injury has been severe enough 

 to tear the peritoneum; or where the hernial pouch collapses or 

 draws together. Hernial coverings of the pouch are the names 

 given to that portion of the skin and subcutaneous cellular tissues 

 which cover that part; in some instances we also include the mus- 

 cles and aponeuroses. The contents of the hernia consist of some 

 portion of the abdominal organs enclosed in the hernial pouch. As 

 a rule, it is the intestines, in most cases the duodenum, and in some 

 cases the jejunum. Very frequently the duodenum may be found 

 lying in the hernia with some portion of the large intestine or 

 uterus, and more rarely the bladder or stomach. Under certain 

 conditions we find a certain quantity of fluid lying in the sac. 

 This is generally serum, and originates from venous stagnation. 



According to the location of the hernial orifice we distinguish 

 umbilical, ventral, inguinal, scrotal, and hernia of the diai)hragm. 

 (320) 



