INGUINAL HERNIA. 



55 



down over this hernia in loops, so as to have the appearance of a cremaster 

 (Cloquet). 



peritoneum 



internal abdominal ring 



. spermatic cord 



tunica vaginalis 



, 



Fig. 25. PERSISTENT VAGINAL PROCESS OF THE PERITONEUM. (After Joessel.) 



The preparation is from a man 20 years of age. The tunica vaginalis is cut off from the vagina 

 process, the tubular portion of which ends blindly a little above the testicle. In the inguinal canal the 

 process becomes gradually narrower up to the internal abdominal ring, through which a probe is 

 introducer! into the cavity. 



A strictly congenital inguinal hernia may occur in the female, the protruded parts being 

 received into the little diverticulum of the peritoneum (canal of Nuck), which sometimes 

 extends into the inguinal canal with the round ligament. But as this process of the 

 peritoneum, in such circumstances, would probably not differ in any respect from the 

 ordinary sac, there are no means of distinguishing a congenital hernia in the female body. 



Direct or internal inguinal hernia. Instead of following the whole course 

 of the inguinal canal, in the manner of the hernia above described, the viscus in 

 this case is protruded from the abdomen to the groin directly through the lower end 

 of the canal, at the external abdominal ring. At the part of the abdominal wall 

 through which the direct inguinal hernia finds its way, there is recognised on its 

 posterior aspect a triangular interval, the sides of which are formed by the epigastric 

 artery, and the margin of the rectus muscle, and the base by Poupart's ligament 

 (fig. 28). It is commonly named the triangle of Hesselbach. The triangle 

 measures about two inches (5 cm.) from above down, and an inch and a half 



