INGUINAL HERNIA 



ii;j5 



to the deep epigastric artery. Direct, because, instead of making its way down 

 the whole oblique canal, it conies by a short cut, as it were, only into the lower 

 part of the canal, and then emerges by the same opening as the other. 



A. Oblique, external inguinal hernia. — Tliis contains its coverings as 

 follows: — 



(1) At the internal ring, or inlet, it obtains three: — (a) Peritoneum; U>) 

 extra-peritoiical fat; (c; inluiidibuliform faijcia, or the layer of transversalis fascia 

 prolonge(l at tliis spot along the cord. 



(2) In the canal it obtains one. As it emerges beneath the lower l>ord<r of the 

 internal (jljlique, it gets some tibres from the cremaster. 



(3) At the external ring, or outlet, the liernia obtains three, viz.: (a) Inter- 

 colunmar fascia; (6) superiicial fascia; and (c) skin. 



B. Direct or internal inguinal hernia. — This does not come through the 

 internal ring, but, making its way through the posterior wall of the lower third of 

 the canal — i.e. the conjoined tendon, either })Ushing this forward or sjditting it — 

 gets its coverings only from structures in relation to this part of the canal. They 

 are — (1) Peritoneum; (2) extra-peritoneal fat; (3) transversalis fascia (not the 



Fig. 703.— Veetical Section of Pelvis passing through the Heads of the 

 Thigh Bones. (Blandin.) 



Deep epigastric vesselsy 



\ INNER BORDER OF INGUINAL CANAL 

 Internal abdominal ring 



Fascia iliaca 



Ohiileraled hijpognstric artery 



External iliac vein 



ILIUM 



VAS OEfERENS 



CRURAL CANAL 



Pelvic fascia 



Obturator fascia 



' ' ' RECTUM 



Levator am/ ischiO-RECTAL FOSSA 

 Kecto-vesical fascia 



ISTEIiy.iL PI Die VES.SEL.'y AXD 

 y Eli YE 



specialised part at the internal ring or infundibuliform fascia); (4; conjoined 

 tendon of internal (jbli(|ue and transversalis. At the outlet of the external ring the 

 coverings obtained are the same as in the oblique hernia, viz. (5) intercolumnar 

 fascia; ((j) sujx'rticial fascia; (7) skin. 



Hitherto the two forms of inguinal hernia have l)een considered from the 

 superficial aspect, that in which they an- met with in jn-actice. The inguinal 

 region should also be studied as to the posterior aspect of its so-called rings and 

 canal, as these have to bear the early stn ss of a commencing hernia. It is against 

 this aspect that a piece of omentum or intestine is constantly and insidiously 

 pressing, and endeavouring to make its way out. Furtliermore. when either of tiie 

 above constituents of hernia have made their way a little farther, and got out into 

 the internal ring or into the canal, the ])atient is no longer sound. 



On the posterior wall are certain conls and dejtressions, marking off regions 

 which correspond to tliose on the surface. 



Tlius, there are three prominent cords, and three fossae. 



Three cords — ( 1 ) Median, or urachus ; (2) lateral, or tlie obliterated hypo- 

 gastric arteries. 



