An Account of an Hydro-Enterocele, Appearing like an Hydro-Sarcocele, and Ending in the Death of the Patient, in Which the Intestine Had Passed from the Hernial Sac, into That of the Hydrocele by Which the Strangulation Was Formed. Communicated by Mr. Le Cat, F. R. S. &c. in a Letter to Charles Morton, Sec. R. S. Translated by J. O. Justamond, Surgeon

XXXI. An Account of an Hydro-enterocele, appearing like an Hydro-sarcocele, and ending in the Death of the Patient, in which the Intestine had passed from the Hernial Sac, into that of the Hydrocele by which the Strangulation was formed. Communicated by Mr. Le Cat, F. R. S. &c. in a Letter to Charles Morton, Sec. R. S. Translated by J. O. Justamond, Surgeon. Read May 28, 1767. In the year 1751, I presented to the Royal Society an observation of a rupture, which had two hernial sacs; at present, I have the honour to send them the history of another kind of rupture with a double sac, much more fallacious and dangerous than the former, since I found myself deceived by it, after the experience of forty years. James Philip Chiquet, aged 65 years, of the Parish of St. Vivien at Rouen, was admitted into our hospital on the 24th of January 1767. The account, which he gave of himself, was, that he had been accustomed to a rupture, which he had not been able to reduce for a fortnight past, and, that since eight days he had been seized with a vomiting, and was incapable of taking any nourishment. ment. Upon examination, the tumor was soft, especially at the upper part towards the ring, which seemed to be so free and disengaged, that the finger with the integuments might be pushed under it: the large cord, which came down to it, was flat, soft, and appeared to be composed entirely of the spermatic vessels enlarged. The extremity of the swelling, which was of the size of a large orange, was evidently a very transparent hydrocele; at the basis of which some hard points were to be felt, which I thought to be schirrous tumors. I concluded, therefore, that his complaint was an old hernia, succeeded by a farcocele and an hydrocele, and that the intestine was at that time returned. I imagined that the vomitings, which were not frequent, might be caused by some other disorder, perhaps by the progress which the farcocele might have made in the cavity of the abdomen; and I also thought that the weak and almost dying state he appeared to be in, was a prognostic of the fatal manner in which those cases usually terminate; for his strength was so far exhausted, that he expired in the following night. I was very desirous of examining the case, having been always induced to suspect, from the vomitings, and the flatness, softness, and size of what passed through the ring, that there was a descent of the intestine. See Tab. XIII. Upon opening the common hernial sac, a b.b. a large portion of intestine, c. d. e.f. g. presented itself, which was very flaccid and almost empty; but what surprized me most, was, to find that the convoluted volved extremity, b. i. k. of this intestine, had insinuated itself into the sac, l. m. n. o. of the hydrocele, which was formed by the vaginal coat of the testicle, P. and, that only this portion of intestine, b. i. k. was strangulated, hard, and changed in colour. The redness was so slight, that this strangulation could scarcely have been the immediate cause of his death; but I rather imagined that an universal decay, and waste of strength, for a long time past, had contributed to hasten this event. If the patient had lived, my design was, first, to have drawn off the water of the hydrocele by an opening made large enough to have examined into the contents of the tumor, which were but indistinctly felt, on account of the surrounding water. According to the discovery I should have made by this opening, I should then have pursued my operation, whether I had met with a sarcocoele or a rupture. In order to put these intentions into execution, I had previously ordered the hair to be shaved off the tumor, and, on account of his great weakness, forbade bleeding, which had been ordered at first. This operation would probably have saved his life, if he had come into the hospital a few days sooner, and his strength had been sufficient to carry him through it. Explanation of Plate XIII. A. The integuments of the abdomen raised. B. The external oblique muscle. D. The ring. E. The Pubis. F. The Penis. G. The right thigh. H. The mesentery. L. Part of the dartos. a. b. b. Part of the hernial sac. c. d. e. f. g. Portion of intestine contained in this sac. h. i. k. The convoluted extremity of this intestine contained in the sac of the hydrocele: l. m. n. o. The sac of the hydrocele composed of the vaginal coat of the testicle. P. The testicle.