340 



SITEGICAL ANATOMY OF HERXL^E. 



The peritoneal sac and the subserous membrane which adheres to ii:, 

 the fascia transversalis, the conjoined tendon of the internal oblique 



Fig. 238. 



Fig. 238. — A Small Oblique and a Direct 

 Inguinal Her.nia, on the IIight Sii>e. 



1, tendon of the external oblique turned 

 down ; 2, internal oblique turned uj) ; S, 

 transversalis ; 4, on its tendon alsove a part 

 of the ei^igastric arterj', which has been ex- 

 posed bj- dividing the fascia transversalis- ; 



5, the spermatic cord (its vessels separated) ; 



6, a bubonocele ; 7, direct hernia protruded, 

 at the conjoined tendon of the two de jier 

 muscles, and covered by a prolongation of 

 the fascia transversalis. 



and transverse muscles, and the in- 

 tercolumnar (external spermatic) 

 fascia derived from the margin of 

 the external abdominal ring', to- 

 gether with the superficial fascia 

 and skin. With regard to the con- 

 joined tendon the hernia may be 

 covered by it, or may pass through 

 an opening in its fibres, or may 

 escape beneath it. 

 The spermatic cord is commonly placed behind the outer part of the 

 hernia. The hernial sac is not, however, in contact with the vessels of 

 the cord. The investments given from the fascia transversalis to those 

 vessels and to the hernia respectively, are interposed. 



But the point at which the internal inguinal hernia passes through 

 the triangle of Hesselbach is subject to some variation. Instead of 

 pushing directly through the external abdominal ring (the most frequent 

 position), the hernia occasionally enters the inguinal canal nearer to the 

 epigastric artery, and, passing through a portion of the canal to reach 

 the external ring, has therefore a certain degree of obliquity. This form 

 of hernia is frequently called internal oblique inguinal. Direct inguinal 

 hernia is very rarely met with in the female. In the single case 

 observed by Richard Quain as well as in the few cases found recorded 

 in books, the hernia though not inconsiderable in size was still covered 

 by the tendon of the external oblique muscle. 



femoraij hernia. 



A femoral hernia leaves the abdomen at tlie groin, passing beneath 

 the lower margin of the broad abdominal muscles, and over the anterior 

 border of the hip-bone immediately at the inner side of the large femoral 

 blood-vessels. It takes its course through the innermost compartment 

 of the sheath of the femoral vessels till it reaches the saphenous opening, 

 when it turns forwards through the opening towards the front of the 

 thigh, and is even l)ent upwards in the groin. 



The femoral sheath is a somewhat funnel-shaped structure em- 

 bracing the upper parts of the femoral artery and vein. It is wide 

 superiorly, but embraces the vessels closely below. It is formed by the 

 lining fasciaj of the abdomen, the transversalis fascia being in front, 

 and the iliac fascia behind. On removing its anterior wall the sheath 



