1046 



THE SURGICAL ANATOMY OF HERNIA. 



versalis. Between the lower border of this muscle and Poupart's ligament a space 

 is left in which is seen the transversalis fascia. 



The inguinal or spermatic canal contains the spermatic cord in the male and 

 the round ligament in the female. It is an oblique canal, about an inch and a half 

 in length, directed downward and inward and placed parallel with, and a little 

 above, Poupart's ligament. It commences above at the internal or deep abdominal 

 ring, which is the point where the cord enters the inguinal canal, and terminates 

 below at the external or superficial ring. It is bounded, in front, by the integu- 

 ment and superficial fascia, by the uponeurosis of the External oblique throughout 

 its whole length, and by the Internal oblique for its outer third ; behind, by the 

 triangular fascia, the conjoined tendon of the Internal oblique and Transversalis, 

 transversalis fascia, and the subperitoneal fat and peritoneum ; above, by the 

 arched fibres of the Internal oblique and Transversalis ; below, by the union of the 

 transversalis fascia with Poupart's ligament. That form of hernia in which the 

 intestine follows the course of the spermatic cord along the inguinal canal is called 

 oblique inguinal hernia. 



The transversalis fascia is a thin aponeurotic membrane which lies between 



Internal 



abdominal ring. 



Epigastric artery. 



FIG. 581. Inguinal hernia. Dissection showing the Transversalis muscle, the transversalis fascia, and the 

 internal abdominal ring. 



the inner surface of the Transversalis muscle and the peritoneum. It forms part 

 of the general layer of fascia which lines the interior of the abdominal and pelvic 

 cavities, and is directly continuous with the iliac and pelvic fasciae. 



In the inguinal region the transversalis fascia is thick and dense in structure, 

 and joined by fibres from the aponeurosis of the Transversalis muscle; but it 

 becomes thin and cellular as it ascends to the Diaphragm. Below, it has the 

 following attachments : external to the femoral vessels it is connected to the 

 posterior margin of Poupart's ligament, and is there continuous with the iliac 

 fascia. Internal to the vessels it is thin, and attached to the os pubis and pectineal 

 line behind the conjoined tendon, with which it is united; and, corresponding to 

 the points where the femoral vessels pass into the thigh, this fascia descends in 

 front of them, forming the anterior wall of the femoral sheath. The spermatic cord 



