. La pratica americana della chirurgia ; un sistema completo della scienza e dell'arte della chirurgia . Colon 17 Csecum 35 intestino 133 pancreas 12 milza 78 rene sinistro 2 fegato 60 rapimento destro 1 ai^ERNIA DOMTNAL. 613 in 266 casi di ernia del diaframma in wliicli diversi organi sono stati involviviLe ha trovato che lo stomaco era nell'ernia in casi di KJl e il colon in145, mentre in casi di OS in cui un solo organo è stato coinvolto lo stomaco wsimplicated in 27, il colon in lo, il piccolo intesthie in (>, e l'omentum onlyonce. Nel caso di un trauma grave, che provoca una grande lacerazione attraverso il dia-ph
1440 x 1735 px | 24,4 x 29,4 cm | 9,6 x 11,6 inches | 150dpi
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. American practice of surgery ; a complete system of the science and art of surgery . Colon 17 Csecum 35 Intestine 133 Pancreas 12 Spleen 78 Left kidney 2 Liver 60 Right kidnev 1 AI^DOMTNAL HERNIA. 613 In 266 cases of hernia of the diaphragm in wliicli several organs were involvedLager found that the stomach was in the hernia in KJl cases and the colon in145, while in oS cases in which only one organ was involved the stomach wasimplicated in 27, the colon in lo, the small intesthie in (>, and the omentum onlyonce. In the case of a severe trauma, which causes a large tear through the dia-phragm, the stomach, lying against this opening, is the first organ to escape; itis foi-ccd dir(>ctly into the i)leural cavity by the difference of pressure in the twocaviti(^s. In a case operat(>d upon by me in 1909 the colon escaped trans-pleurally into the open air underneath the liver, the chest being torn open aboveso as to expose the dome of the diaphragm. In spite of the facts that the lungalso prolapsed and that half a dozen ribs were fractured, the patient made a good. Fig. 251.—Dissection Exposing to View a False Diaphragmatic Hernia, or one without HernialSac. Nearly all of the small intestines have escaped into the left pleural cavity. (From Enderlen andGasser.) recovery. The wound in the diaphragm was sutured from above. Suppurationensued in the chest and the patient had a recurrence of ventral hernia afterleaving the hospital. In the preceding year I reported two other cases of dia-phragmatic hernia which had come under my care in the Cook County Hospital.In one of these—a case of stab wound, recovery took place; in the other atraumatic rupture of the diaphragm was discovered at the autopsy. When thestomach enters the chest cavity, it is apt to drag after it consecutively the colon, the jejunum and small intestine, the spleen, and the omentum. In small woundsthe omentum may be first to enter the opening. It contracts adhesions at thispoint and afterward act
