Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The inguinal and iliac portions of the fascia transversalis join along
the line of Poupart's ligament, A C. The iliac vessels, in their passage
to the thigh, encounter the fascia at the middle third of the crural
arch formed by the ligament, and take an investment (the sheath, R) from
the fascia. The fore part of this sheath is mentioned as formed by the
fascia transversalis--the back part by the fascia iliaca; but these
distinctions are merely nominal, and it is therefore unnecessary to
dwell upon them. The sheath of the femoral vessels is also
funnel-shaped, and surrounds them on all sides. Its broad entrance lies
beneath the middle of Poupart's ligament. Several septa are met with in
its interior. These serve to separate the femoral vessels from each
other. The femoral vein, O, Plate 30, is separated from the falciform
margin, S s, of the saphenous opening by one of these septa. Between
this septum and the falx an interval occurs, and through it the crural
hernia usually descends. These parts will be more particularly noticed
when considering the anatomy of crural hernia.
Beneath the fascia transversalis is found the subserous cellular
membrane, which serves as a connecting medium between the fascia and the
peritonaeum. This cellular membrane may be considered as the seventh
inguinal layer. It is described by Scarpa (sull' Ernie) as forming an
investment for the spermatic vessels inside the sheath, where it is
copious, especially in old inguinal hernia. It is also sometimes mixed
with fatty tissue. In it is found embedded the infantile cord--the
remains of the upper part of the peritoneal tunica vaginalis--a
structure which will be considered in connexion with congenital herniae.
By removing the subserous cellular tissue, we lay bare the peritonaeum,
which forms the eighth layer of the inguinal region. Upon it the
epigastric and spermatic vessels are seen to rest. These vessels course
between the fascia transversalis and the peritonaeum. The internal ring
which is formed in the fascia, K h, may be now seen to be closed by the
peritonaeum, I. The inguinal canal, therefore, does not, in the normal
state of these parts, communicate with the general serous cavity; and
here it must be evident that before the bowel, which is situated
immediately behind the peritonaeum, I, can be received into the canal, H
h, it must either rupture that membrane, or elongate it in the form of a
sac.
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