838 SURGICAL ANATOMY OF FEMORAL HERNIA. 



wards are peritoneum, subserous areolar tissue, the septum crurale, crural sheath, 

 cribriform fascia, superficial fascia, and integument. 1 



Varieties of Femoral Hernia. If the intestine descends along the femoral canal 

 only as far as the saphenous opening, and does not escape from this aperture, 

 it is called incomplete femoral hernia. The small size of the protrusion in this 

 form of hernia, on account of the firm and resisting nature of the canal in 

 which it is contained, renders it an exceedingly dangerous variety of the disease, 

 from the extreme difficulty of detecting the existence of the swelling, especially 

 in corpulent subjects. The coverings of an incomplete femoral hernia would 

 be, from without inwards, integument, superficial fascia, falciform process of 

 fascia lata, fascia propria, septum crurale, subserous cellular tissue, and perito- 

 neum. When, however, the hernial tumor protrudes through the saphenous 

 opening, and directs itself forwards and upwards, it forms a complete femoral 

 hernia. Occasionally, the hernial sac descends on the iliac side of the femoral 

 vessels, or in front of these vessels, or even sometimes behind them. 



The seat of stricture of a femoral hernia varies: it may be in the peritoneum 

 at the neck of the hernial sac ; in the greater number of cases it would appear 

 to be at the point of junction of the falciform process of the fascia lata with the 

 lunated edge of Gimbernat's ligament ; or at the margin of the saphenous open- 

 ing in the thigh. The stricture should in every case be divided in a direction 

 upwards and inwards; and the extent necessary in the majority of cases is 

 about two or three lines. By these means, all vessels or other structures of 

 importance, in relation with the neck of the hernial sac, will be avoided. 



' Sir A. Cooper has described an investment for femoral hernia under the name of " Fascia 

 propria," lying immediately external to the peritoneal sac, but frequently separated from it by 

 more or less adipose tissue. Surgically, it is important to remember the existence (at any rate 

 the occasional existence) of this layer, on account of the ease with which an inexperienced ope- 

 rator may mistake the fascia for the peritoneal sac, and the contained fat for omentum. Anatomi- 

 cally, this fascia appears to be identical with what is-called in the text " subserous areolar tissue," 

 the areolar tissue being thickened .and caused to assume a membranous appearance, by the 

 pressure of the hernia, 



