The disease seems not to be a rare one, as Hennig collected forty-one cases from literature up to 1884.
Symptoms and what has already been said, it is evident that if a processus vaginalis persists, fluid will collect in it rarely in early, and more frequently during advanced life; further, the sacks so formed are at first usually the size of a pigeon-egg, and situated in the inguinal region, and may exist for years without causing annoyance to the patient. In some cases the swelling was at first reducible, a communication with the abdominal cavity existed; later it became irreducible, adhesions having formed in the iuguinal canal, or obliteration of the processus vaginalis hav ing taken place.
Usually from injury, but at times without appreciable cause, inflam mation and suppuration set in; occasionally also blood extravasation takes place in and about the sac. With the inflammation a rapid increase of the swelling occurs, accompanied by violent pains. The integument becomes reddened and swollen, and symptoms of irritation of the adjacent peritoneum are developed, thus creating a condition similar to incarcer ated hernia.
to what has been said, when we have to deal with hydrocele peritonealis or cystica, or when the formation of the latter from the former is observed, the diagnosis can be made with certainty from the history, course, form and situation of the swelling at the ingui nal canal. Often the diagnosis will be doubtful, as other tumors produce the same symptoms. But if inflammation sets in or about the sac, the resemblance to incarcerated hernia is so great that it can not be differen tiated from it, for the tympanites and constipation which are absent in these varieties of swelling may also be absent in incarcerated hernia if it only involves an intestinal diverticulum or omentum.
Treatment.—Hydrocele hardly requires treatment before symptoms of inflammation appear. To prevent the formation of hernia, and also because the walls of the peritoneum may yet become adherent in early life, a truss should be worn if the swelling or fluid is reducible. Small
swellings of this variety, which usually cause no inconvenience, should not be touched. When larger and not communicating with the abdomi nal cavity, they may be advantageously punctured and injected with iodine or simply incised. Hennig punctured a cyst of the round ligament, 3} inches long by 2* inches in breadth, which extended by a round prolon gation into the inguinal canal, and inserted a double iron wire. C. Braun extirpated a goose-egg-sized cyst with serous limpid contents, which ex tended from the left abdominal ring into the labia majora, and terminated by a strong pedicle in the inguinal canal. If with inflammation and sup pnration in or about a female hydrocele symptoms of incarceration are simulated, the only thing to be done is to immediately open it layer by layer, being prepared to perform lierniotomy if necessary.
Sew Growths of the round Ligaments.—As the round ligaments are true prolongations of the uterus, especially of its superficial muscular fibres, it is not strange that the same new growths occur on them. F. Winckel was, to our knowledge, the first to show the uterus of a woman seventy-six years of age, with two pea-sized pediculated myomatous polyps of the round ligaments attached to it; and, according to Sanger, Spen cer Wells has from 1865 to 1866 operated for two fibrous tumors, which were connected with the round ligament, and were of the size respectively of an orange and cocoanut. Since, in rapid succession, a whole series of operations performed by Leopold, Bleinwachter, Duplay, Hofmokl, San ger and others have been published, where smaller and very large tumors of a fibromyomatous character, connected with the anterior abdominal wall or situated therein, and originating from the round ligaments, were removed. Slinger has collected up to 1882 twelve cases of this nature, and described them fully.