Fig. 14S3. 



Mouth 



Peritoneum 

 /^Transversalis fascia 

 ,^>^Muscle 



Superficial fascia and skin 



PRACTICAL CONSIDERATIONS: ABDOMINAL HERNIA. 1763 



alba or the linea semilunaris {ventral hernia) , through the pelvic diaphragm, — the coc- 

 cygeus and levator ani {perineal hernia) ; or through Petit' s triangle (page 530) or 

 the superior lumbar triangle of Grynfelt and Lesshaft (page 1777), or "Braun's space" 

 (page 1777) {lumbar hernia). Other varieties depend upon {d) congenital defects, 

 as in some forms of inguinal., umbilical, ventral, and diaphrag^natic her^iia ; or in the 



varieties of properitoyieal or interstitial hernia 

 that accompany misplaced or undeveloped 

 testes ; or {e) pathological changes, as in 

 those ventral hernies that follow abscesses or 

 wounds. 



This classification, although not exhaustive, 

 will serve as a basis for the later and more de- 

 tailed consideration of the anatomical factol^s 

 concerned in the production of special external 

 herni^e and of their symptoms. 



The component parts of an external ab- 

 dominal hernia (Fig. 1483) are (i) the sac, 

 consisting of distended and protruding parietal 

 peritoneum, and subdivided into {a) the mouth, 

 the aperture corresponding to the internal her- 

 nial orifice ; {b) the body, the expanded pro- 

 truding portion, the lowest portion of which is 

 called \.\ie fu?idus ; and {c) the neck, the constricted portion connecting the body 

 and mouth ; and (2) the contents, which in the order of frequency are ileum, omen- 

 tum, jejunum, sigmoid, caecum, and transverse colon. More rarely the ascending 

 and descending colon, the bladder, the ovary, and the various abdominal viscera, with 

 the exception of the liver, have been found among the contents of herniae. 



Inguinal hernia, by far the most frequent of all the varieties of hernia, 

 (95-97 per cent, in males, 55-60 per cent, in females), may best be studied anatom- 



FlG. 1484. 



dus 



Diagram showing general components of external 

 abdominal hernia. 



Anterior superior iliac spine '- 



Poupart's ligament- 

 Falciform process- 

 Iliac portion of fascia lata- 



Femoral ring. 

 Femoral artery 

 Femoral vein 



Internal saphenous vein 



Aponeurosis of external oblique 



Intercolumnar fibres 



— External abdominal ring 

 External pillar 

 Internal pilla> 



Gimbernat's ligament 



Pubic portion of fascia lata 

 -Spermatic cord 



— scrotum 



Dissection of right inguinal region, showing external abdominal ring and saphenous opening in fascia lata. 



ically by considering its mode of production when, (a) as a direct result of some 

 developmental defect, it is present at or soon after birth ; {b) the hernial sac being 

 present congenitally, the hernia follows some increase of intra-abdominal pressure ; 

 or, {c) as a consequence of a less marked — or less complete — original defect or of 



