272 
INTERNAL HERNIOTOMY* 
divided at the point of strangulation. A slight incision suffices to enable 
the contents of the sac to be returned to the abdomen, unless the hernia 
is adherent. 
In umbilical and abdominal hernhe, hernia knives are replaced bj 
blunt-pointed tenotomes, which have been constructed of various forms, 
A special herniotome is only necessary in inguinal hernias in the horse. 
Internal herniotomy has the advantage over the external operation 
that one can determine the condition of the strangulated bowel, and 
should the latter prove to be necrotic, can either proceed to further 
treatment or resection of the necrotic portion. Reposition, under these 
circumstances, would destroy any chance of recovery. It should, how¬ 
ever, be repeated that dark coloration does not always indicate necrosis. 
It is necessary in such cases to promptly decide whether to attempt 
resection of the necrotic bowel, a proceeding which, though certainly 
offering greater chance of success in carnivora than in herbivora, 
especially in horses, is even in them eminently fatal. Incarcerated 
portions of omentum, which, however, are seldom met with, are first 
ligatured with aseptic material and then cut off, and the wound treated 
as before described. It is of the highest importance to secure asepsis 
and prevent prolapse of the intestine. Perfect cleanliness ensures the 
first, and carefully-inserted quilled sutures lead to proper union of the 
edges of the wound. 
Should resection of necrotic portions of intestine be determined on, 
it is very important to avoid infecting the peritoneal cavity with intestinal 
contents, and to carefully provide for union of the ends of the cut 
portions. The intestine is drawn forward as far as necessary, and 
protected by layers of cloth dipped in warm disinfectant solutions. 
After separating the necrotic portion with scissors, the ends must be 
rinsed with carbolic or sublimate solution, and their contents, as far as 
possible, removed without soiling the wound. An assistant compresses 
the intestine to prevent further passage of contents from the anterior 
end, and the parts are then so brought together that the two surfaces of 
serosa are in apposition. To effect this, the free edges of the posterior 
portion are turned inwards, the anterior portion pushed into this, and 
the two sewn together with closely applied stitches. After once more 
carefully cleansing the intestine, it is returned, the wound disinfected, 
and stitches inserted as above described. Experiments made many 
years ago with the simplest apparatus in cases of invagination show 
that under some circumstances, especially in oxen, resection of the 
intestine may prove successful (compare with the section on “ Suturing 
the Intestine ”)• 
