THE INFERIOR EPIGASTRIC ARTERY 



615 



passes in front of the linea semieircularis (Douglas' fold) and turns upward be- 

 tween the rectus and its sheath. Higher, it enters the substance of the muscle, 

 and anastomoses with the superior epigastric, descending in the rectus from the 

 internal mammarj-. 



The situation of the artery between the two inguinal rings should be borne in 

 mind in the operation for strangulated inguinal hernia, and its near proximity to 

 the upper and lateral side of the femoral ring should not be forgotten in the 

 operation for femoral hernia. The arterj^ is accompanied by two veins which 

 end in a single trunk before opening into the external iliac vein. 



The branches of the inferior epigastric are small and include: — (a) The external spermatic 

 [a. spermatica externa], which runs with the ductus through the inguinal canal, supphes the 

 cremaster muscle, and anastomoses with the internal spermatic, external pudendal, and perineal 

 arteries. In the female a corresponding artery [a. lig. teretis uteri] accompanies the round hga- 



FiG. 495.— The Inferior (Deep) Epigastric Artery. (From Kelly, by Brodel). 



— Psoas 



Genito-femoral 

 nerve 



Ovarian vessels 

 External iliac 



artery 

 External iliac 

 vein 



ment of the uterus through the inguinal canal and anastomoses in a similar manner. (6) The 

 pubic [ramus pubicus], which passes below, or sometimes above, the femoral ring to the back 

 of the pubis, where it anastomoses with the pubic branch of the obturator. This branch, 

 though usually small, is occasionally considerably enlarged, when its exact course becomes of 

 great interest to the surgeon. Thus it may descend immediately medial to the vein, and there- 

 fore lateral to the femoral ring, or it may course medially in front of the femoral ring and turn 

 downward either behind the os pubis or immediately behind the free edge of the lacunar (Gim- 

 bernat's) hgament, in which situation it would be exposed to injury in the operation for the re- 

 lief of a strangulated femoral hernia. In such ca.ses the obturator may lose its connection with 

 the hypogastric and actually arise from the inferior epigastric. Very rarely the inferior epi- 

 gastric loses its connection with the external iUac and arises from the obturator. This abnormal 

 origin of the obturator is said to occur once in every three subjects and a half; but the abnormal 



