Two cases of congenital umbilical hernia into the cord : operation, recovery / by J. Collins Warren.

  • Warren, John Collins, 1842-1927.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Two cases of congenital umbilical hernia into the cord : operation, recovery / by J. Collins Warren. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    were also given every two hours. A small amount of cream and water had been given up to this time, but the whole amount hardly exceeded one ounce. The child looked pale and pinched, but it slept well the following night. The next morning vomiting had ceased; it had passed gas several times, and the hemorrhages did not recur. On the fifth day the child took the breast for the first time. During l^he next two weeks it suffered greatly from colic and indigestion, but gained steadily in weight, and now (four weeks) weighs eleven pounds. The stitches were not removed until the fourteenth day to avoid a hernia. There is, however, a slight impulse, at one spot, over an area about the size of a pea. The baby wears a gauze pad and a firmly pinned band of flannel. This affection is termed by Steiner “ Hernia funiculi um- bilicalis.” Chadwick1 explains the existence of this form of hernia as due partly to deficient development of the abdominal plates. He says: “ If, however, the volume of the abdominal organs be too great to be easily embraced by the under-sized abdominal walls at the period when the latter should normally close, the intra-abdominal pressure prevents the retreat within the abdomi- nal walls of a certain portion of those intestinal convolutions which have, until that time, lain normally in the umbilical cord.” In the omphalo-mesenteric duct which connects the alimentary canal with the umbilical vesicle we find a cause for the extra- abdominal position of some of the coils of intestine. If the umbilical vesicle persists until a later period than usual, that portion of the intestinal tube to which it is attached is anchored outside the umbilical ring. Chadwick describes several museum specimens in which not only the intestines and the liver, but the heart and stomach, formed a part of the hernial contents. Howard Marsh says:2 “It is a familiar anatomical fact that from about the sixth to the twelfth week of intra-uterine life the caecum and neighboring portion of the ileum are contained in the part of the umbilical cord which is next the body of the 1 Gynaecological Transactions, vol. i.