333 



SURGICAL ANATOMY OF HEllNIiE. 



those vessels. The deep epigastric nrterv is close to the inner border 

 of the internal ring, and the femoral vessels are beneath it, and rather 

 to its inner side. 



Fi-. 233. 



^i^:^'^ 



./ 



Fig. 233. — Deeper Dissection of the Abdominal Wall in the Groin. 

 The aponeurosis of the external oblique muscle having been divided and turned down, 

 the internal oblique is brought into view with the spermatic cord escaping beneath its 

 lower edge ; 1, aponeurosis of the external oblique ; 1', lower part of the same turned 

 down ; 2, internal oblique muscle ; 3, spermatic cord ; 4, saphenous vein. 



The spermatic cord, which occnpies the inguinal canal, is composed 

 of the arteries, veins, lymphatics, nerves, and excretory duct (vas 

 deferens) of the testis, together with a quantity of loose areolar tissue 

 mixed up vrith those parts. 



The coverings given from the constituent parts of the abdominal 

 wall to the spermatic cord, besides the integuments, are, from the 

 external ring a prolongation of the intercolumnar or spermatic fascia ; 

 the cremasteric muscle and fascia from the lower border of the internal 

 oblique muscle, and a thin, funnel-shaped prolongation of the trans- 

 versalis fascia from the edge of the inner ring (infundibuliform ftiscia). 

 Lastly, on the inside of the abdominal walls is the peritoneum, and a thin 

 layer of areolar tissue lying between the peritoneum and fascia transver- 

 salis, and usually containing a small quantity of sub-peritoneal fat. 



Vaeieties of inguinal herni^e. — Two principal forms of inguinal 

 hernia are described which are distinguished according to the part of 

 the canal in which they first enter, as well as by the position which 

 they bear with respect to the epigastric artery. Thus, when the hernia 

 takes the course of the inguinal canal from its commencement, it is 

 named oblique, because of the direction of the canal, or external, from, 

 the position which its neck bears with respect to the epigastric artery. 

 On the other hand, when the protruded part, without following the 



