264 THE ABDOMEN AND PELVIS 



hernia and incises the neck of the sac in a lateral direction, the 

 vessels will be wounded ; or if he mistakes an old-standing 

 oblique for a direct hernia and cuts in a medial direction, the 

 same accident will occur. 



The incision for direct hernia is practically the same as that 

 employed in dealing with the oblique variety (p. 261), but the 

 coverings of the sac are somewhat different. After the external 

 spermatic fascia has been divided, the spermatic cord within 

 its cremasteric and infundibuliform fasciae is found lying to 

 the lateral side, and the hernia, covered by a thin expansion 

 from the falx inguinalis (conjoined tendon), to the medial side. 

 When this layer is incised the hernial sac is exposed covered by 

 a sheath which, though derived from the fascia transversalis, 

 is quite distinct from the internal spermatic (infundibuliform) 

 fascia of the cord (Fig. 77). 



In the female, the inguinal canal is occupied by the round 

 ligament of the uterus, which is attached to the skin and fascia 

 of the labium majus. In the foetus, it also lodges a peritoneal 

 process, the Canal of Nuck, which corresponds to the processus 

 vaginalis in the male. At birth, the canal of Nuck should be 

 completely closed, but it may remain patent and give rise to 

 inguinal hernia. This condition occurs rarely in adult women, 

 but is not uncommon in female infants and young girls. As 

 the hernia increases in size it drags into its wall a part of the 

 suspensory ligament of the ovary (p. 387), which, at its lateral 

 extremity, is not far distant from the abdominal inguinal ring. 

 As a result the ovary and the distal part of the uterine (Fallopian) 

 tube are often found in the sac. 



Imperfect closure of the canal of Nuck may lead to encysted 

 hydrocele of the round ligament. 



Varicocele is a varicose condition of the veins of the 

 pampiniform plexus (p. 257). In adolescents it is almost 

 invariably on the left side, and many explanations have been 

 suggested, (a) The left spermatic vein, which is formed by the 

 union of the pampiniform veins, joins the left renal almost at 

 right angles, whereas the right spermatic vein joins the inferior 

 vena cava very obliquely. It has been urged that, owing to its 

 method of termination, the outflow from the spermatic vein is 

 not so free on the left side as it is on the right, (b) The total 

 length of the spermatic vein and pampiniform plexus is less 

 on the right side than the left, since the left testis hangs lower 

 in the scrotum and the left spermatic vein terminates at a higher 



