Fig. 169. Inguinal Region, 4th Layer. Hernial Orifices, Iliac Bursa. 



Male aged 60. The Spermatic Cord has been drawn out of the Inguinal Canal 

 and cut off. Vas Deferens (blue). Fascia of Penis is opened up and the Dorsal 

 Vessels and Nerves are exposed. External part of Fascia Lata has been removed. 

 Anterior Crural and External Cutaneous Nerves have been lopped off short. 

 A piece has been cut out of the Ilio-Psoas to expose the Iliac Bursa (pink). 

 The Pelvis and Head of the Femur are indicated in dotted lines. The dotted 

 ellipse over the Head of the Femur indicates the position and size of the com- 

 munication between the Iliac Bursa and the Hip-faint (in this case). 



Immediatelv external to the Common Femoral Artery, but on a slightly 

 deeper plane, are the Ilio-Psoas Muscle and the Anterior Crural Xerve. 



A very large bursa (Iliac Bursa) separates the Ilio-Psoas Muscle from the 

 Horizontal Ramus of the Pubis and the Capsule of the Hip-Joint whereby the 

 Muscle pla}'s over the edge of the bone without friction. The Capsule of the 

 Hip-Joint is weak at its point of contact with the Iliac Bursa, and in some cases 

 (I in 10) there exists a communication between these 2 cavities. 



This Bursa may extend some distance into the Pelvis which occurrence 

 is of practical importance in connection with primary disease of this Bursa. When 

 swollen the difficulty of diagnosis arises between enlarged l\-mphatic glands, 

 aneurysm of the Femoral Artery, or disease of the Hip. An accurate anatomical 

 knowledge of this bursa is the only clue to a correct diagnosis. Again inflam- 

 mation ma\' spread from the Hip-Joint into the Bursa, via a direct communication, 

 b}' piercing the thin septum, and further extend into the Pelvis. 



The figure also shews the important relations of the Hernial Orifices. 

 The fibres of the External Abdominal Oblique Muscle diverge at an acute angle, 

 and form the 2 pillars of the External Abdominal Ring. The Internal Pillar ends 

 in the middle line (or reaches to the opposite side) at the Symphj'sis Pubis by 

 sending fibres into the Suspensory Ligament of the Penis. The Outer Pillar is 

 chiefly inserted into the Pubic Spine. The angle between the diverging fibres 

 and the anterior aspect of the cord are covered by intercolumnar fibres which 

 hold the two pillars together. Poupart's Ligament is a thickened fibrous cord 

 or rather a tendon or tendinous cord (the lower border of the External Abdominal 

 Oblique Muscle). 



From the External PiUar and PoUTART's Ligament which are blended 

 together, many fibres spread in various directions, and to some of these names 

 have been applied. The fibrous mass which stretches across to the Fascia covering 

 the Pectineus Muscle, near the Spine of the Pubis, and forming a triangular 

 ligament with the base pointing outwards has been called GiMBERNAT's Ligament 

 (Fig. 170). The fibres directed upwards and backwards to reach the bone, have 

 been called the Ilio-Pubic band. Both ligaments are usuallj- blended together. 

 These structures are not constant, and their descriptions are most variable. 



