Femoral Hernia 



313 



fascia in front and of the iliac fascia behind. These two pro- 

 longations join on either side of the vessels, and the funnel-shaped 

 investment thus formed is the crural sheath ; it blends with the 

 connective-tissue sheath of the vessels about an inch below Poupart's 

 ligament. 



Three compartments are made in the crural sheath by two antero- 

 posterior fibrous septa ; the outermost compartment contains the 

 common femoral artery, the middle the vein, and the innermost a 

 lymphatic gland. The anterior crural nerve, being beneath the iliac 

 fascia, cannot be within the sheath. 



The innermost compartment is the femoral or crural canal ; it ex- 

 tends less than an inch into the thigh : from the base of Gimbernat's 

 ligament to the margin of the saphenous opening ; its abdominal 

 orifice, which is about large enough to admit the top of the little finger, 

 is overlaid by the peritoneum ; between it and the peritoneum is a 

 (practically) unimportant layer of sub-peritoneal connective tissue, 

 which, on account of its covering the aperture, is called the septum 

 crurale. See illustration on p. 306. 



Relations of the crural canal. In front is Poupart's lig'ament ; 

 behind is the pubic part of fascia lata covering the ramus of pubes and 

 the pectineus ; internally is Gimbernat's ligament ; and externally is 

 the common femoral vein, and, possibly, the irregular obturator artery. 

 Its apex reaches down to the top of the saphenous opening. The 

 spermatic cord, which lies along Poupart's ligament, is just above and 

 in front of the canal, and the deep epigastric artery, in its inward 

 ascent, lies external and superior to it. 



Femoral hernia descends through the crural ring and down the 

 crural canal to the top of the saphenous opening. The bowel takes as 

 its coverings a sac of peritoneum ; then, probably, the sub-peritoneal fat 

 under the name of septum crurale ; in the canal it derives an invest- 

 ment from the anterior wall of the crural sheath that is from the pro- 

 longation of the fascia transversalis. Arrived at the lower limit of the 

 crural canal, the hernia comes forward through the saphenous open- 

 ing, taking the deep layer of the superficial or cribriform fascia, the 

 fatty layer, and the skin. Thus, the coverings from above downwards 

 are skin, two layers of superficial fascia, crural sheath, septum crurale, 

 and peritoneum. 



The course of a femoral hernia is downwards, into the canal ; 

 then forwards through the saphenous opening ; and, lastly, upwards 

 towards Poupart's ligament or the iliac crest. 



The hernia is superficial to and above the saphenous vein. 



Before employing taxis the thigh should be flexed and slightly 

 inverted so as to relax the fascia lata, and especially its falciform 

 border, against which the bowel would otherwise be bruised. The 

 fingers and thumb of the left hand are arranged around the neck of 

 the hernia to steady it and the tumour is gently but firmly squeezed 





