Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The exact position which the epigastric, L, Plate 31, and spermatic
vessels, M, bear in respect to the internal ring, is a point of chief
importance in the surgical anatomy of the groin; for the various forms
of herniae which protrude through this part have an intimate relation to
these vessels. The epigastric artery, in general, arises from the
external iliac, close above the middle of Poupart's ligament, and
ascends the inguinal wall in an oblique course towards the navel. It
applies itself to the inner border of the internal ring, and here it is
crossed on its outer side by the spermatic vessels, as these are about
to enter the inguinal canal.
The inguinal canal is the natural channel through which the spermatic
vessels traverse the groin on their way to the testicle in the scrotum.
In the remarks which have been already made respecting the several
layers of structures found in the groin, I endeavoured to realize the
idea of an inguinal canal as consisting of elongations of these layers
invaginated the one within the other, the outermost layer being the
integument of the groin elongated into the scrotal skin, whilst the
innermost layer consisted of the transversalis fascia elongated into the
fascia spermatica interna, or sheath. The peritonaeum, which forms the
eighth layer of the groin, was seen to be drawn across the internal ring
of this canal above in such a way as to close it completely, whilst all
the other layers, seven in number, were described as being continued
over the spermatic vessels in the form of funnel-shaped investments, as
far down as the testicle.
With the ideas of an inguinal canal thus naturally constituted, I need
not hesitate to assert that the form, the extent, and the boundaries of
the inguinal canal, as given by the descriptive anatomist, are purely
conventional, and do not exist until after dissection; for which reason,
and also because the form and condition of these parts so described and
dissected do not appear absolutely to correspond in any two individuals,
I omit to mention the scale of measurements drawn up by some eminent
surgeons, with the object of determining the precise relative position
of the several parts of the inguinal region.
The existence of an inguinal canal consisting, as I have described it,
of funnel-shaped elongations from the several inguinal layers continued
over the cord as far as the testicle, renders the adult male especially
liable to hernial protrusions at this part. The oblique direction of the
canal is, in some measure, a safeguard against these accidents; but this
obliquity is not of the same degree in all bodies, and hence some are
naturally more prone to herniae than others.
DESCRIPTION OF THE FIGURES OF PLATES 30 & 31.
PLATE 30.
A. The anterior superior iliac spine.
B. The umbilicus.
C. The spine of the pubis.
D. The external oblique muscle; d, its tendon. .
E. The internal oblique muscle; e, its tendon.
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