3 88 APPLIED ANATOMY. 



side of the rectus muscle. On this account a direct hernia rarely enters to the inner 

 side of the hypogastric fold (Fig. 399). 



Coverings of a Direct Inguinal Hernia. The conjoined tendon is pro- 

 longed outward from the edge of the rectus muscle two-third^ of the distance to the 

 epigastric artery, and sometimes more. A direct hernia piercing the abdominal wall 



Fold of Douglas (linea semicircularis) 

 \ 



Urachus 



External inguinal 

 Middle ing 



Internal inguinal fossa 



us muscle 



Obliterated hypogas- 

 tric artery 



Deep epigastric artery 



Poupart's ligament 

 Vas deferens 

 External iliac artery. 



rial f< 



FIG. 399. View of the posterior surface of the abdominal walls, showing the inguinal fossae and triangle of 



Hesselbach (the latter in red). 



to the inside of the hypogastric artery (very rare) will push in front of it the peritoneum, 

 subperitoneal fat, transversalis fascia, conjoined tendon, and intercolumnar fascia, mak- 

 ing its exit at the inner side of the external abdominal ring. The common site is just 

 to the outer side of the obliterated hypogastric artery, and it pushes in front of it the 

 conjoined tendon and intercolumnar fascia, and makes its appearance at the outer side 



Tntercolumnar fascia from the ex- 

 ' ternal oblique 



Conjoined tendon 



Direct inguinal hernia 



Spine of pubis 

 Spermatic cord 



FIG. 400. Direct inguinal hernia. 



of, or through, the external abdominal ring (Fig. 400). If it pierces the middle 

 inguinal fossa farther out, and just to the inside of the epigastric artery, it passes t o 

 the outside of the conjoined tendon, and is covered instead by the cremaster musc'e. 

 Division of the stricture which occurs here must be made upward and inward, 

 because to its outer side lie the epigastric vessels. 



