Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
While the hernia occupies the canal, F H, without projecting
through the external ring, H, it is named "incomplete." When it has
passed the external ring, H, so as to form a tumour of the size and in
the situation of f g, it is named "complete." When, lastly, the hernia
has extended itself so far as to occupy the whole length of the cord,
and reach the scrotum, it is termed "scrotal hernia." These names, it
will be seen, are given only to characterise the several stages of the
one kind of hernia--viz., that which commences to form at a situation
external to the epigastric artery, and, after following the course of
the spermatic vessels through the inguinal canal, at length terminates
in the scrotum.
The external inguinal hernia having entered the canal, P, (Plate 32,) at
a situation immediately in front of the spermatic vessels, continues, in
the several stages of its descent, to hold the same relation to these
vessels through the whole length of the canal, even as far as the
testicle in the scrotum. This hernia, however, when of long standing and
large size, is known to separate the spermatic vessels from each other
in such a way, that some are found to lie on its fore part--others to
its outer side. However great may be the size of this hernia, even when
it becomes scrotal, still the testicle is invariably found below it.
This fact is accounted for by the circumstance, that the lower end of
the spermatic envelopes is attached so firmly to the coats of the
testicle as to prevent the hernia from either distending and elongating
them to a level below this organ, or from entering the cavity of the
tunica vaginalis.
The external form of inguinal hernia is, comparatively speaking, but
rarely seen in the female. When it does occur in this sex, its position,
investments, and course through the inguinal canal, where it accompanies
the round ligament of the uterus, are the same as in the male. When the
hernia escapes through the external abdominal ring of the female groin,
it is found to lodge in the labium pudendi. In the male body, the
testicle and spermatic cord, which have carried before them investments
derived from all the layers of the inguinal region, have, as it were,
already marked out the track to be followed by the hernia, and prepared
for it its several coverings. The muscular parietes of the male inguinal
region, from which the loose cremaster muscle has been derived, have by
this circumstance become weakened, and hence the more frequent
occurrence of external inguinal hernia in the male. But in the female,
where no such process has taken place, and where a cremaster does not
exist at the expense of the internal oblique and transverse muscles, the
inguinal parietes remain more compact, and are less liable to suffer
distention in the course of the uterine ligament.
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