

ANATOMY OP INGUINAL HERNIA. 171 



cord, and also carries before it a pouch of peritoneum, but 

 only for a short distance ; the diverticulurn, which the peri- 

 toneum forms, is called the canal of Nuck. 



DIRECT INGUINAL HERNIA commences in the internal 

 inguinal fossa, in a triangle, called the triangle of Hessel- 

 bach, formed by the external edge of the rectus muscle, 

 Poupart's ligament, and the obliterated hypogastric artery ; 

 it carries before it the peritoneum which forms the sac of 

 the hernia, the transversalis fascia, the conjoined tendon 

 (this, however, it sometimes splitg, and passes through, 

 instead of pushing before it), the spermatic fascia, the 

 superficial fascia, and the skin; it then descends toward the 

 scrotum. The epigastric artery and the spermatic cord 

 are both left upon the outer side of this form of hernia, 



OBLIQUE INGUINAL HERNIA commences in the external 

 inguinal fossa, and from that derives its peritoneal sac ; 

 the internal inguinal ring entered, it pushes before it the 

 infundibuliform fascia, and when in the canal, the cremaster 

 muscle ; at the external ring, the spermatic fascia, the 

 superficial fascia, and the skin ; it then descends toward 

 the scrotum. In this form of hernia, the spermatic cord is 

 beneath, and behind the tumor formed by it ; the epigastric 

 artery is upon the inside, the reverse of its position in direct 

 hernia. Oblique hernia, from its size and long existence, 

 may so enlarge and drag upon the internal ring, as to bring 

 it behind the external ring, and thus assume the appearance 

 of a hernia primarily direct. The artery, of course, retains 

 its relative position. 



When the portion of peritoneum, carried before the testi- 

 cle in its descent, has not been obliterated, and the intes- 

 tine passes through the tube thus left, into the tunica vagi- 

 nalis testis, it is called a congenital hernia. When this tube is 

 partially obliterated, and admits the intestine into its upper 

 part only, it pushes down behind that portion which has 

 formed the tunica vaginalis testis, and is called an encysted, 

 or infantile hernia. Inguinal hernia rarely occurs in the 

 female, but all the various forms have been noticed ; in 

 females the hernia descends into the labia pudendi. 



