THE INGUINAL REGION. 181 



companies the cord and testis in its descent during foetal 

 life remains patent, and the gut falls into this pouch, 

 and thus lies in contact with the testicle. (In congenital 

 hydrocele the condition of the parts is the same.) 



In the infantile form, the peritoneal pouch is only 

 partially obliterated, and the sac descends along the in- 

 guinal canal into the scrotum, behind the pouch ; hence 

 there are three layers of peritoneum in front of the gut 

 and its proper investment viz., two of the tunica vagi- 

 nalis testis, and the sac itself. 



Direct or internal inguinal hernia differs in its course 

 from oblique, in not passing through the inner ring, but 

 through the space known as the triangle of Hesselbach, 

 the boundaries of which are, externally, the epigastric- 

 artery ; internally, the outer edge of the rectus, and infe- 

 riority. Poupart's ligament. This space is filled in on its 

 inner two-thirds by. the conjoined tendon, and for the 

 rest by the fascia transversalis. Any hernial protrusion 

 through this interval and emerging from the external 

 ring, would have the deep epigastric artery external to 

 its sac, and the spermatic cord internal and posterior. 

 This form of rupture may either force its way through 

 the conjoined tendon, or push it before it. 



Coverings of Direct Inguinal Hernia. The same as 

 those already given in the case of the oblique variety, 

 with the exception that the conjoined tendon takes the 

 place of the cremaster, the infundibuliform fascia being 

 replaced by that portion of the fascia transversalis be- 

 hind or immediately contiguous to the conjoined tendon- 



The seat of stricture, in strangulation, is either at the 

 neck of the sac, at the external ring, or is due to the 

 fissured edges of the conjoined tendon. The incision for 

 its relief is to be made upwards. 



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