THE ABDOMINAL WALLS 259 



naculum has failed to acquire its connection with the bottom 

 of the scrotum,, but instead has become attached to the skin 

 of the region in which the testis is found. It may lie in the 

 perineum, in the groin, or near the anterior superior iliac spine, 

 but it always maintains its normal relation to the processus 

 vaginalis, which is also misplaced. 



Congenital Inguinal Hernia ; Congenital Hydrocele. 

 Numerous developmental errors may occur in connection with 

 the closure of the processus vaginalis. All the congenital 

 varieties of inguinal hernia and of hydrocele result from such 

 errors. In Fig. 78 (b) the normal condition is depicted. The 

 processus remains patent below as the tunica vaginalis testis, 

 but above it is represented by a fibrous cord. In (a) the 

 processus remains patent throughout, i.e. a persistence of the 

 fcetal condition. If the opening at the neck is sufficiently wide, 

 bowel or omentum will enter the sac and pass down to its lower 

 end. It will then be in close contact with the testis and only 

 separated from it by the visceral layer of the patent tunica 

 vaginalis (vaginal type of oblique inguinal hernia). If the 

 opening at the neck is too small to permit .the passage of a 

 hernia, serous fluid from the peritoneal cavity may find its way 

 into the sac and give rise to an Intermittent Hydrocele. The 

 condition is not always present, as when the child lies down 

 the fluid passes back into the general peritoneal cavity. Owing 

 to this intermittent character, it may be mistaken for a hernia. 

 Further, it may be confused with a hydrocele of the cord or of 

 the tunica vaginalis, because it cannot be reduced by taxis. 



In (c) the tunica vaginalis has been shut off, but the proximal 

 part of the processus remains patent and maintains its connection 

 with the general peritoneal cavity. This condition gives rise to 

 the Funicular Type of Oblique Inguinal Hernia, which constitutes 

 95 per cent (Stiles) of all congenital herniae. If the neck is not 

 large enough to admit a hernia, an intermittent hydrocele of 

 the funicular type may occur. The conditions shown in (d) 

 and (e) are very similar. The tunica vaginalis is closed above, 

 and the proximal part of the processus remains patent. In 

 both, but more especially in (e) } the line of closure has been 

 oblique and not horizontal as in (c). In order to open the sac 

 of a hernia of the funicular type affecting (e) } three layers of 

 peritoneum must be incised. This variety was formerly ex- 

 plained as an acquired hernia descending behind a partially 

 closed processus vaginalis. 



17 a 



