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Irreducible RuptureCategory: Digestive Organs This is when the rupture cannot be returned into the abdominal cavity, and it is without any symptoms of strangulation. They are of long standing and of a large size. This condition is often due to carelessness of a patient in not keeping in a reducible rupture with a proper support. Adhesions form, holding the rupture. Even if it is small, it gives rise to much discomfort and the patient is always in danger of strangulation of the rupture. Operation for radical cure is generally a success. Strangulation Hernia or Rupture. This means the rupture is so tightly constricted that it cannot be returned into the abdominal cavity, and its circulation is interfered with; then there is not only obstruction to the passage of the feces, but also an arrest of circulation in the protruded portion of bowel which, if not relieved, results in gangrene and death. This occurs more often in old than in recent ruptures and more often in congenital than in acquired rupture. Symptoms. Sudden and complete constipation with persistent vomiting. The lump may be tense, hard and irreducible. Then there is faintness, collapse; severe abdominal pain, complete constipation, with no gas passing, then vomiting, at first of food, then of the bile-stained fluid and finally of fluid with a bowel odor. All these symptoms increase and the patient gradually sinks from exhaustion in eight or nine days, though in very acute cases the patient may die within forty-eight hours. MOTHERS' REMEDIES. Strangulated Hernia, Hop Poultice for. "A large warm poultice of hops over the abdomen will be found one of the best known means of relieving strangulated hernia." PHYSICIANS' TREATMENT. It must be reduced or an operation must be performed and soon. To reduce. The patient is put under an anesthetic and placed on his back with the hips (pelvis) raised and the thigh of the affected side flexed, bent up and rotated inward if the rupture be inguinal or femoral. This motion relaxes the parts. The neck of the sac is then seized with the thumb and fingers of one hand, and thus fixed, while with the other hand, the operator endeavors to return the strangulated gut by gentle pressure in the proper direction. In femoral rupture, this is at first downward, to bring the gut opposite the opening then backward and then upward. In groin (inguinal) rupture it is usually slightly upward and outward. It must be coaxed, kneaded and squeezed carefully. Care must be taken. If it cannot be returned in from five to ten minutes no further time should be wasted, but an operation should be performed immediately. This consists in cutting down to the constriction and through it, thus allowing the rupture to be reduced. The patient should be kept in bed and treated the same way as for other abdominal operations. Caution. Persons with rupture must be very careful not to lift or fall. If a support is worn it must fit perfectly and be worn with comfort. Next: INTESTINAL COLIC. (Enteralgia) Previous: RUPTURE (Hernia)
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