3 io 



Inguinal Hernia 



INGUINAL HERNIA 



Oblique inguinal hernia follows the course of the spermatic cord 

 through the internal abdominal ring and along the inguinal canal. 

 Emerging on the outer side of the deep epigastric artery, it is also 

 called external inguinal hernia. It passes in front of the spermatic 

 cord, and may enter the scrotum or the labium. 



If the protrusion be arrested in the inguinal canal, it is called 

 bubonocele, from its resemblance to a gland (povfav, gland; 107X17 

 tumour); its coverings then vary with the extent to which it has 

 advanced. 



On account of the recent descent of the testis, and the imperfect 

 closure of the canal, oblique inguinal hernia is common in childhood ; 

 in the subsequent growth and development of the child it may be ex- 

 pected to disappear under the influence of a truss. This hernia passes 

 down into the funicular process of peritoneum which 

 accompanied the testis (see p. 429), and if it descend far 

 enough it comes in contact with the testis, lying above 

 and in front of it. Though this kind of hernia is fre- 

 quently met with in adults, it bears the name con- 

 genital, as expressive of its anatomical peculiarity. In 

 the female, congenital hernia descends in the canal of 

 Nuck (p. 390- 



When the funicular process is closed only at the ab- 

 dominal end, a hernia in a sac of its own may descend behind the 

 tunica vaginalis, so that in front of the bowel there are three layers of 



peritoneum, the two layers of the tunica, 

 and its own sac. This constitutes an 

 infantile hernia. If the sac of an in- 

 fantile hernia push its way into the top 

 of the open tunica the variety is called 

 encysted. 



Occasionally an inguinal hernia in the 

 adult, though emerging through the ex- 

 ternal abdominal ring, has not passed 

 down with the cord, but has escaped from 

 the abdominal cavity through that part 

 of the anterior wall which is bounded externally by the deep epigas- 

 tric artery, internally by the rectus, and below by the inner end of 

 Poupart's ligament and the pubic crest. This space is Hesselbach's 

 triangle, and the hernia which passes through it is designated, from 

 the short and straight course which it takes to the surface of the body, 

 direct, or, from the position of its egress as regards the epigastric 

 artery, internal. The triangle is figured on p. 306. 



The coverings of direct hernia vary according to the part of 



Congenital her 

 nia ; x, testis. 



Hernia behind 

 tunica vagi- 

 nalis, T v. 



Encysted her- 

 nia into tu- 

 nica vagina- 

 lis, T V. 



