1028 



SURGICAL ANATOMY OF HERNIJE. 



their relative position results from the poiuts at which they respectively 

 pass through the ring, the former being upon the crista of the pubes, 



Fig. 709. 



Fig. 709. A DIRECT INGUINAL HER- 

 NIA ON THE LEFT SIDE, COVERED 

 BY TEE CONJOINED TENDON OF THE 

 INTERNAL OBLIQUE AND TRANS- 

 VERSE MUSCLES. 



1, aponeurosis of the external ob- 

 lique ; 2, internal oblique turned up ; 

 3, transversal! s muscle ; 4, fascia 

 transversalis ; 5, spermatic cord ; 6, 

 the hernia. A small part of the epi- 

 gastric artery is seen through an 

 opening made .in the transversalis 

 fascia. 



while the latter drops over the 

 outer pillar of the opening. 

 The hernial sac is not, how- 

 ever, in this case (as the sac 

 of the external form of the 

 disease is) in contact with the 

 vessels of the cord. The invest- 

 ments given from the fascia 



transversalis to those vessels and to the hernia respectively, are inter- 

 posed. 



But the point at which the internal inguinal hernia passes through the 



Fig. 710. 



Fig. 710. A SMALL OBLIQDE INGUINAL 

 HERNIA, AND A DIRECT ONE ON THE 

 RIGHT SIDE. 



A little of the epigastric artery has 

 been laid bare, by dividing the fascia 

 transversalis immediately over it. 1, 

 tendon of the external oblique; 2, in- 

 ternal oblique turned up ; 3, transver- 

 salis ; 4, its tendon (the epigastric artery 

 is shown below this number) ; 5, the 

 spermatic cord (its vessels separated) ; 

 6, a bubonocele ; 7, direct hernia pro- 

 truded beneath the conjoined tendon of 

 the two deeper muscles, and covered by 

 an elongation from the' fascia trans- 

 versalis. 



triangular space above described, 

 as marked on the posterior aspect 

 of the abdominal wall, is subject 

 to some variation. Instead of 

 pushing directly through the ex- 

 ternal abdominal ring, (the most 

 frequent position), the hernia 



occasionally enters the inguinal canal nearer to the epigastric artery, and, 

 passing through a portion of the canal to reach the external ring, has 

 therefore a certain degree of obliquity. This change in position may coin- 

 cide with a change of the peritoneal fossa, which furnishes the hernial sac 



