DIRECT INGUINAL HERXLE. 



339 



following the whole course of the inguinal canal, in the manner of the 

 hernia above described, the viscus in this case is protruded from the 



Fis. 236. 



Fig. 236. — Internal View of the 

 Vessels related to the Groin. 



A portion of the wall of tlie abdo- 

 men and pelvis of the left .side, seen 

 from behind. 1, symphysis of the 

 pubis ; 2, irregular surface of the 

 hip-bone separated from the sacrum ; 

 ■3, ischial .sjjine ; 4, ischial tuberosity ; 

 5, obturator internus ; 6, rectus, 

 covered with an elongation from 7, 

 fa.scia transversalis ; 8, fascia iliaca 

 covering the iliacus nuiscle ; 9, psoas 

 niagnus cut ; 10, iliac artery ; 11, 

 iliac vein ; 12, epigastric artery and 

 its two accompanying veins ; 13, vessels 

 of the spermatic cord, entering the 

 abdominal wall at the internal ring 

 the vas deferens joining them from 

 below ; 14, two obtui-ator veins ; 15, 

 the obliterated umbilical artery. 



abdomen to the groin directly 

 through the lower end of the 

 canal, at the external abdomi- 

 nal ring. At the part of the 



abdominal wall through which the direct inguinal hernia finds its way, 

 there is recognised on its posterior aspect a triangular interval, 



Fig. 237. — A Direct Incuinal Her- Fig. 237. 



NiA ON THE Left Side, covered 



BY THE CoN,TOINED TeNDON OF THE 



Internal Oblique and Trans- 

 versalis Muscles. 



1, aponeurosis of the external ob- 

 lique ; 2, internal oliliciue turned up ; 

 3, transversalis muscle ; 4, fascia 

 transversalis ; 5, spermatic cord ; 6, 

 the hernia. A small part of the epi- 

 gastric artery is seen through an 

 opening made in the transversalis 

 fascia. 



the sides of which are formed 

 by the epigastric artery, and 

 the margin of the rectus mus- 

 cle, and the base by Poupart's 

 ligament. It is commonly 

 named the triangle of Hessel- 

 bach. Through this space the 

 hernia is protruded, carrying 



before it a sac from the fossa of the peritoneum internal to the obliterated 

 hypogastric artery; and it is in general forced onwards directly into the 

 external abdominal ring. 



The coverings of this hernia, taking them in the order which they 

 are successively applied to the protruded viscus, are the following: — 



z 2 



