THE ABDOMINAL WALLS 



261 



If the testis with its patent processus emerges from the 

 inguinal canal but fails to descend into the scrotum,, a superficial 

 inguinal hernia may result. In these cases the sac is often 

 bilocular, the one enlargement being situated under the skin 

 and the other in the inguinal canal. Occasionally the sac of an 

 inguinal hernia not only extends into the scrotum but possesses 

 a second loculus either just outside or within the inguinal canal. 



An Acquired Oblique Hernia enters the inguinal canal 

 at the abdominal inguinal ring and makes its way down into 

 the scrotum inside the spermatic cord (Fig. 77). The con- 

 stituents of the 

 cord are spread 

 out over the sur- 

 face of the sac and 

 the ductus defer- 

 ens is always found 

 on its posterior 

 aspect. 



Inguinal Her- 

 nia: Radical Cure. 

 The Incision for 

 inguinal hernia is 

 made along the 

 medial half or two- 

 thirds of the line 

 joining the anterior 

 superior iliac spine 

 to the root of the 



penis, and should expose, in its lateral 

 part ; the aponeurosis of the external 

 oblique. The fasciae of Camper and 

 Scarpa (p. 240) and the superficial epigastric and external pudic 

 arteries, which lie between them, are divided. At the medial 

 part of the wound the spermatic cord is exposed and the surgeon 

 can at once define the subcutaneous inguinal ring. The cord is 

 freed and lifted up to the surface, dragging the testis upwards 

 in the scrotum. In order to avoid injuring the ductus deferens, 

 forceps are carefully applied to the margins of the cord, which is 

 put on the stretch downwards and medially (Stiles). The external 

 spermatic fascia (p. 255) is very thin, and the muscular fibres of 

 the cremaster, which are very well marked in the male infant, 

 are visible through it. These two layers are carefully stripped off 



FIG. 80. Diagram of the In- 

 guinal Canal to show the 

 Position of an Extra- parietal 

 Interstitial Hernia. Portions 

 of the different layers of the 

 abdominal wall have been 

 removed. The patent pro- 

 cessus vaginalis and the peri- 

 toneum are shown in blue. 



