FEMORAL HERNIA 



1401 



Boundaries. — Laterally, a septum between it and the vein; medially, base of the lacunar 

 ligament and meeting of fascia iliaca and transversalis; behind, fascia iliaca; in front, fascia 

 transversalis. 



Contents. — Cellular tissue and fat, continuous with extra-peritoneal fatty layer. A lym- 

 phatic node, which is inconstant. Lymphatics passing from inguinal nodes to those in the 

 pelvis. 



(8) Femoral ring. — This is mainly an artificial product. It is the upper or 

 abdominal opening of the femoral canal. Shape: oval, with its long axis trans- 

 verse. It is larger in women. Boundaries: medially, the lacunar ligament; 

 laterally, the femoral vein; in front, the inguinal ligament and the thickening 

 of the transversalis fascia attached to it, and called 'the deep crural arch'; 

 behind the pectineus and Cooper's ligame nt, a thickened fascial bundle attached 



Fig. 1123. — Irregularities of the Obturator Artery. (After Gray.) 

 A ^ ,. 



Deep circumflex iliac artery 



External iliac artery 

 External iliac vein 



Obturator foramen 



Internal ring, with spermatic 

 vessels cut short in it 



Inferior epigastric artery 



Lymphatic node in femoral ring 



The obturator artery, given off 

 from the external iliac with the 

 inferior epigastric, descends to 

 gain the obturator foramen, but 

 at a safe distance from the 

 femoral ring 



The obturator artery, coming off 

 from the inferior epigastric, 

 takes a course so near to the 

 femoral ring that it would very 

 likely be divided by the bis- 

 toury introduced from without 

 to divide the base of the lacunar 

 ligament, the cause of the con- 

 striction 



to the linea terminalis (fig. 1122), It is closed by the septum crurale, which 

 is a barrier of fatty connective tissue, continuous with the extra-peritoneal 

 fatty layer, perforated by lymphatics passing upward to the pelvic nodes. 



Position of vessels around the ring. — Laterally the femoral vein; above,''the 

 epigastric vessels as they ascend from the external iliac vessels, pass close to the 

 upper and lateral aspect of the ring; immediately in front are the cord and sper- 

 matic vessels always to be remembered in this hernia in the male; toward the 

 medial side there may be an unimportant anastomosis between the epigastric 

 artery above and the obturator below. 



If from dilatation of the above anastomosis the obturator artery comes off abnormally 

 from the inferior epigastric, it will descend, and usually does so, close to the junction of the ex- 

 ternal iliac and common femoral vein, and thus to the lateral and so the safe, side of the ring 

 (fig. 1123, A). In a very few cases it curves more medially, close to the lacunar ligament, and 

 thus to the medial side of the ring, and is then in great danger (fig. 1123, B). In two out of 



