INGUINAL HERNIA. 51 



ANATOMY OP THE GROIN" : HERNIA. 



Two kinds of abdominal hernias have such definite and important relations that, 

 the regions concerned require special notice in a work on anatomy. These are 

 inguinal hern-tee, which are associated with the spermatic cord in their passage 

 through the abdominal wall, and femoral hernice, which descend through the 

 femoral canal on the inner side of the femoral vessels. 



INGUINAL HERNIA. 



The inguinal canal, through which the spermatic cord passes from the cavity 

 of the abdomen to the scrotum, begins at the internal abdominal ring, and ends 

 at the external ring. It is oblique in its direction, being nearly parallel with and 

 immediately above the inner half of Poupart's ligament, and it measures about an 

 inch and a half (3'5 cm.) in length. The external ring (Vol. II, p. 329) is imme- 

 diately above and external to the pubic spine ; the internal (ib., p. 336) is midway 

 between the anterior superior iliac spine and the pubic symphysis, and half an inch 

 (1 cm.) above Poupart's ligament. In front, the canal is bounded by the aponeurosis 

 of the external oblique muscle in its whole length, and at the outer end also by the 

 fleshy part of the internal oblique ; behind it is the transversalis fascia, together with, 

 towards the inner end, the conjoined tendon of the two deeper abdominal muscles 

 and the triangular fascia. Above the canal are the arched lower borders of the 

 internal oblique and transversalis muscles ; and below, it is bounded by Poupart's 

 and Gimbernat's ligaments, which separate it from the sheath of the large blood- 

 vessels descending to the thigh, and from the femoral canal at the inner side of 

 those vessels. Below the internal ring, and separated therefrom by Poupart's 

 ligament, is the external iliac artery, giving off its epigastric branch, which at first 

 runs inwards, and then ascends close to the inner border of the opening (fig. 28). 



The spermatic cord, which occupies the inguinal canal, is composed of 

 the arteiy, veins, lymphatics, nerves, and excretory duct of the testis (vas deferens), 

 together with a quantity of loose areolar tissue. 



Coverings of the cord. The coverings given from the constituent parts of 

 the abdominal wall to the spermatic cord, besides the integuments, are, from the 

 external ring the intercolumnar or spermatic fascia, the cremasteric muscle 

 and fascia from the lower border of the internal oblique muscle, and a thin, funnel- 

 shaped prolongation of the transversalis fascia from the edge of the inner ring 

 (infundibuliform fascia). Beneath the last, the areolar tissue uniting together the 

 constituents of the cord is continuous with the subperitoneal areolar layer. 



Peritoneal fossae. When the lower part of the anterior abdominal wall 

 is viewed from within, the peritoneum is seen to form a series of depressions, 

 which are separated by more or less prominent folds. Thus, along the middle line 

 is the plica urachi (plica umlilicalis media'), which extends from the apex of the 

 bladder upwards along the urachus to the umbilicus; a little outside this is the 

 well-marked plica hypogastrica (plica umlilicalis lateralis), containing the obliterated 

 hypogastric artery, and also extending from the bladder to the umbilicus ; and still 



Fig. 22. ANATOMY OF HERNIA : SUPERFICIAL VIEW. (Gr. D. T.) 



On the left side, only the skin and superficial fasciae have been removed, exposing above Poupart's 

 ligament the aponeurosis of the external oblique, with the spermatic cord emerging through the external 

 abdominal ring, and below Poupart's ligament the fascia lata with the internal saphenous vein passing 

 through the lower part of the saphenous opening and piercing the femoral sheath. 



On the right side, the inguinal portion of the external cblique has been removed, bringing into view 

 part of the internal oblique muscle and the cremaster ; and below Poupart's ligament the iliac part of 

 fascia lata has been detached from Poupart's ligament and reflected, so as to expose the front of the 

 femoral sheath. 



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