432 SURGICAL APPLIED ANATOMY. [Chap, xix 



of the following nerves : offsets of the posterior 

 branches of the lumbar nerves, some branches of the 

 sacral nerves, the lateral cutaneous branch of the last 

 dorsal nerve, the iliac branch of the ilio-hypogastric 

 nerve, offsets of the external cutaneous nerve, and 

 large branches of the small sciatic. 



It should be remembered that the pelvic viscera 

 can be readily reached through the sciatic foramina 

 from the buttock. I once saw a case at the London 

 Hospital of a man who was admitted with an 

 apparently insignificant stab of the buttock. He died 

 in a few days, of acute peritonitis ; and the autopsy 

 showed that the dagger had passed through the gi-eat 

 sacro-sciatic foramen, had entered the bladder and 

 allowed urine to escape into the peritoneal cavity. 

 The rectum has also been damaged in injuries to the 

 buttock, and Anger records a case of an artificial anus 

 situate upon the buttock, that had followed a gunshot 

 wound, which, after involving the buttock, had opened 

 up the caecum. 



2. The region of Scarpa's triangle. 

 Surface anatomy. The most important land- 

 marks in the region of the groin, the anterior superior 

 iliac spine, the spine of the pubes, and Poupart's 

 ligament, arfi readily made out. To the two spines 

 reference has already been made (page 288). Poupart's 

 ligament follows a curved line, with its convexity down- 

 wards, drawn between these two projections. It can 

 be felt in any but stout persons, its inner half more 

 distinctly than its outer, and even in very fat indivi- 

 duals its position is indicated by a slight furrow. The 

 ligament is relaxed, and rendered less distinct when 

 the thigh is flexed and adducted, or when it is 

 rotated in. 



The line, often called " Holden's line," is thus 

 described by that surgeon : " When the thigh is even 

 slightly bent, there appears a second furrow in the 



