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21 But if omentum comes down, the groin is to be cut into as described above, and the tunics drawn down. Then it must be considered whether the mass is rather large or only small. For when quite small the omentum may be pushed back beyond the groin into the abdominal cavity, either with the finger, or with the opposite end of a probe; if the mass is larger what has prolapsed from the belly should be left hanging out of the wound, and smeared with caustic medicaments until it mortifies and falls off. In this condition too some transfix the tumour with a doubly threaded needle, and tie the two ends of each thread on opposite sides, under which treatment it mortifies, but more slowly. This may, however, be hastened by smearing the omentum beyond the ligature with medicaments which eat it away but do not erode; the Greeks call them septa. Some have cut away the omentum with shears. If it is quite small, this is unnecessary; if larger, bleeding may follow, because the omentum itself is connected with blood vessels, some rather large. And although in the case of an abdominal wound, prolapsed omentum is cut away[p. 415] with shears after it has mortified and there is no other safe way of removing it, no precedent can be drawn from that for this case. As to the treatment of the wound when the omentum has been replaced, it should be stitched; if the quantity was large, and has been left outside to mortify, the margins should be pared as described above. But if a hydrocele occurs, in boys an incision is to be made in the groin, unless in their case too the large quantity of liquid prevents it; in men, and when there is a large amount of fluid, a scrotal incision is made. So then if the incision is in the groin, when the tunics have been drawn forwards the humour must then be evacuated there; if in the scrotum, and if the trouble is immediately beneath, there is nothing to do but to let out the fluid and cut away any membranes which are keeping it in; then the incision is washed with water to which salt or nitre has been added. If the fluid is under the middle tunic, or under the inner one, these tunics have to be brought out of the scrotal wound, and cut away.
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