178 ANATOMY IN A NUTSHELL. 



Behind. — Iliac fascia. 



Kvn i;\ \i.ly. — A septum between it and the vein. 



Internally. — Gimbemat's ligament and the meeting of the iliac fascia 

 and the transversalis fascia. 



The femoral ring is the upper opening of the femoral canal and is oval 

 shaped about half an inch in diameter. It is larger in women. 



The relations of the femoral ring. 



I.\ Front. — Poupart's ligament and the deep crural arch which is a thick- 

 ening of the transversalis fascia. 



Behind. The Pectineus muscle and the ilio-peetin'eal line. 



[ntern u.i.y. — Gimbernal 's ligament. 



Extern u.i.v.- Femoral vein. 



It is closed by the septum crurale. which is composed of fatty connective 

 tissue and is perforated by lymphatics passing from the superficial to the deep 

 group. There is a small lymphatic gland here. On the upper and outer angle 

 of this ring is the deep epigastric artery. On the upper and inner margin is 

 the obturator artery, when it arises from a common trunk with the deep epi- 

 gastric artery which it does in about thirty per cent of the cases. 



The coverings of the umbilical hernia are: 



1. Peritoneum. 



2. Extra-peritoneal fatty tissue. 



3. Transversalis fascia. 



4. Prolongation of scar tissue of the umbilicus stretched out. 



0. Superficial fascia. 

 (i. Skin. 



Congenital hernia (Plate CCLXXXVIII) is applied to hernia which takes 

 place from birth or during any period of life, if the conditions favorable to its 

 occurrence existed at birth. The vaginal portion of the tunica vaginalis may 

 not close after the descenl of the testicle in the fetus, and in this case when there 

 is a hernia the intestine does not push forward a sac which comes from the 

 parietal layer of the peritoneum, but instead it lies in a sac formed by the 

 tunica vaginalis which is still connected with the peritoneal cavity. These 

 forms of hernia ate called congenital and are always oblique. 



The following are the different kinds of congenital hernia: 



1. Hernia in the tunica \ vginalis testis. In this form of congenital 

 hernia the intestine surrounds the testis and the sac is formed by the tunica 

 vaginalis testis, because the intestine passes through the narrow canal which 

 is present between the cavity of the peritoneum and the tunica vaginalis tes- 

 tis, the original communication between them is not obliterated. 



2. Hernia in the funIcular portion of the tunica vaginalis. In 

 this form of congenital henna the sac is formed by the original pouch of the 

 peritoneum which descends with the testicle but is shut off from the tunica 

 vaginalis testis by a thin septum. The canal above this septum being still 

 presenl and communicating with the peritoneal cavity. 



'.]. Infantile hernia. This form of congenital hernia is rare and is pro- 

 duced by the descent of the hernia through the internal abdominal ring but 



