188 SURGICAL ANATOMY OF THE 



Besides hernise, the fold of the groin is the seat of 

 other tumors, of which an accurate knowledge of the 

 anatomy of the region affords the chief help towards the 

 diagnosis ; such as aneurism, the pointing of a psoas 

 abscess, an inflamed lymphatic gland, cysts, enlargement 

 of the bursa3 beneath the tendon of the psoas, which is 

 often connected with the hip-joint. 



Artificial Anus. In cases of strangulated hernia, 

 whether inguinal or crural, when the bowel has become 



FIG. 33. 



Sketch of artificial anus. 

 1. Mesentery. 2. Eperon. 3. Opening of artificial anus. 



gangrenous, or if the intestine has been wounded, and 

 given way in a state of gangrene, surgical principles in- 

 dicate the removal of this portion, and the subsequent 

 formation of an artificial anus, and the following condi- 

 tion generally results, which explains the impediments 

 in the way of its healing : The edges of the gut become 

 attached to the aperture in the abdominal wall, and that 

 generally at an angle which soon becomes acute. As the 

 upper portion of the intestine only transmits faeces, the 

 lower remains as a useless tube, and consequently con- 

 tracts in its calibre. That portion of the bowel to which 

 the mesentery is attached, becomes drawn out into a 

 spur-like process (eperon) ; which acting as a valve, serves 



