836 



SURGICAL ANATOMY OF FEMORAL HERNIA. 



sures about half an inch, and it is larger in the female than in the male, which 

 is one of the reasons of the greater frequency of femoral hernia in the former 

 sex. 



Fig. 452. Hernia. The Kelations of the Femoral and Internal Abdominal Rings, seen from 



within the Abdomen. Eight Side. 



Position of Parts around the Ring. The spermatic cord in the male, and round 

 ligament in the female, lie immediately above the anterior margin of the femo- 

 ral ring, and may be divided in an operation for femoral hernia if the incision 

 for the relief of the stricture is not of limited extent. In the female, this is 

 of little importance, but in the male the spermatic artery and vas deferens may 

 be divided. 



The femoral vein lies on the outer side of the ring. 



The epigastric artery, in its passage inwards from the external iliac to the 

 umbilicus, passes across the upper and outer angle of the crural ring, and is 

 consequently in danger of being* wounded if the stricture is divided in a direction 

 upwards and outwards. 



The communicating branch between the epigastric and obturator lies in front 

 of the ring. 



The circumference of the ring is thus seen to be bounded by vessels in every 

 part excepting internally and behind. It is in the former position that the 

 stricture is divided in cases of strangulated femoral hernia. . 



The obturator artery, when it arises by a common trunk with the epigastric, 

 which occurs once in every three subjects and a half, bears a very important 

 relation to the crural ring. In some cases (Fig. 453), it descends on the inner 

 side of the external iliac vein to the obturator foramen, and will consequently 

 lie on the outer side of the crural ring, where there is no danger of its being 

 wounded in the operation for dividing the stricture in femoral hernia. Occa- 

 sionally, however, the obturator artery curves along the free margin of Gim- 

 bernat's ligament in its passage to the obturator foramen; it would, conse- 

 quently, skirt along the greater part of the circumference of the crural canal, 

 and could hardly avoid being wounded in the operation (Fig. 454). 



Septum Crurale. The femoral ring is closed by a layer of condensed areolar 

 tissue, called, by J. Cloquet, the septum crurale. This serves as a barrier to the 

 protrusion of a hernia through this part. Its upper surface is slightly concave, 

 and supports a small lymphatic gland, by which it is separated from the subse- 

 rous areolar tissue and peritoneum. Its under surface is turned towards the 



