PRACTICAL CONSIDERATIONS: ABDOMINAL HERNIA. 1763 



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

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

 the superior lumbar triangle of Grynfeltand 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 diaphragmatic hernia ; or in the 



varieties of properitoneal or interstitial hernia 



FIG. 1483. that accompany misplaced or undeveloped 



Mouth _. testes ; or (e) pathological changes, as in 



those ventral her nits that follow abscesses or 



wounds. 



Peritoneum 



nsversalis fascia 



Superficial fascia and skin 



dus 



This classification, although not exhaustive, 

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

 tailed consideration of the anatomical factors 

 concerned in the production of special external 

 herniae 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- 



Diagram showing general components of external . , -r / ?\ ^1 L j ^.L j j 



abdominal hernia. nial orifice ; (0) the body ', the expanded pro- 



truding portion, the lowest portion of which is 



called the fundus ; and (<:) the neck, the constricted portion connecting the body 

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

 turn, 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, 

 (9597 per cent, in males, 5560 per cent, in females), may best be studied anatom- 



FIG. 1484. 



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 pillar 



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, (#) 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 



