1058 



THE SURGICAL ANATOMY OF HERNIA. 



the ilium to the spine of the os pubis. From this latter point it is reflected outward, 

 to be attached to the pectineal line for about half an inch, forming Gimbernat's 

 ligament. Its general direction is curved downward toward the thigh, where it 

 is continuous with the fascia lata. Its outer half is rounded and oblique in 

 direction. Its inner half gradually widens at its attachment to the os pubis, is 

 more horizontal in direction, and lies beneath the spermatic cord. Nearly the 

 whole of the space included between the crural arch and innominate bone is filled 

 in by the parts which descend from the abdomen into the thigh (Fig. 588). The 

 outer half of the space is occupied by the Iliacus and Psoas muscles, together with 

 the external cutaneous and anterior crural nerves. The pubic half of the space is 

 occupied by the femoral vessels included in their sheath, a small oval-shaped 

 interval existing between the femoral vein and the inner wall of the sheath, 

 which is occupied merely by a little loose areolar tissue, a few lymphatic vessels, 



Crural 



Poupart s ligament, branch Anterior crural, 

 of genito- 



Extemai 



cutaneous nerve. 



crural. 



Iliac portion of Sheath of 

 fascia lata. \ vessels. 



Femoral vein. 

 Femoral ring. 



Gimbernat's 

 ligament. 



Femoral artery. 

 FIG. 588. Structures which pass beneath the crural arch. 



and occasionally by a small lymphatic gknd ; this is the femoral ring, through which 

 the gut descends in femoral hernia. 



Gimbernat's Ligament (Figs. 588, 589) is that part of the aponeurosis of the 

 External oblique muscle which is reflected backward and outward from the spine 

 of the os pubis, to be inserted into the pectineal line. It is about half an inch in 

 length, larger in the male than in the female, almost horizontal in direction in the 

 erect posture, and of a triangular form, with the base directed outward. Its base. 

 or outer margin, is concave, thin, and sharp, and lies in contact with the femoral 

 sheath. Its apex corresponds to the spine of the os pubis. Its posterior margin 

 is attached to the pectineal line, and is continuous with the pubic portion of the 

 fascia lata. Its anterior margin is continuous with Poupart's ligamenj;. 



