342 



SURGICAL AXATOMY OF HERXI^. 



pelvis at the outer side of the rin^^ or immediately behind it ; and in 

 some rare cases that vessel passes over the ring to its inner side. An 

 obturator vein also has occasionally the same course ; and small 

 branches of the epigastric artery will be generally found ramifying on 

 the posterior aspect of Gimbernat's ligament. In the male the sper- 

 matic vessels are separated from the canal only by the femoral arch. 



Fig. 240. Fig. 240. — View op the relations of' 



THE Vessels of the Groin to a 

 Femoral Hernia, &c. (from R. 

 Quain). ;\- 



In the upper part of the figure a 

 portion of the flat muscles of the 

 abdomen has been removed, dispLaying 

 in part the transversalis fascia and 

 peritoneal lining of the abdomen ; in 

 the lower the fascia lata of the thigh is 

 in part removed and the sheath of the 

 femoral vessels opened : the sac of the 

 femoral hernial tumour has also been 

 Oldened. 



a, anterior sui^erior spinous process- 

 of the ilium ; b, aponeurosis of the ex- 

 ternal oblifjue muscle above the exter- 

 nal inguinal aperture ; c, the abdomi- 

 nal peritoneum and fascia trans- 

 versalis ; (?, the iliac portion of the 

 fascia lata near the saphenous opening ;, 

 c, sac of the femoral hernia ; 1, points, 

 to the femoral artcrj ; 2, femoral vein 

 at the place where it is joined by the 

 saphenous vein ; 3, epigastric artery 

 and vein passing up towards the back 

 of the rectus muscle ; + , placed upon 

 the iipper jaart of the femoral vein, 

 close below the common ti'unk of the 

 epigastric and an aberrant obturator artery ; the latter artery is seen in this case to pass 

 close to the vein and between it and the neck of the hernial tumour. 



Descent of the hernia. — When a femoral hernia is being formed, 

 the protruded part is at first vertical in its course ; but at the lower end 

 of the canal it bends forward at the saphenous opening, and, as it 

 increases in size, ascends over the iliac part of the fascia lata and the 

 femoral arch. "Within the canal the hernia is very small, being con- 

 stricted by the unyielding structures which form that passage ; but 

 when it has passed beyond the saphenous opening, it enlarges in the 

 loose fatty layers of the groin ; and, as the tumour increases, it extends 

 outwards in the groin towards the iliac spine of the hip-bone. 



Coverings of the hernia. — The coverings of a femoral hernia in 

 order from within outwards are, the peritoneum (which forms the sac); 

 the septum crurale and the sheath of the femoral vessels. These two 

 structures combined constitute a single very thin covering, known as 

 tiie fascia propria of the hernia (Cooper). It sometimes happens that 

 the hernia is protruded through an opening in the sheath, which there- 

 fore in that event docs not contribute to form the fascia propria. Lastly 

 the hernia is covered by the cribriform ftxscia, covering the saphenous, 

 opening ; the superficial fascia and skin. 



