Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The internal inguinal hernia takes its peritonaeal covering (the sac)
from the inner fossa, Q R, Plate 32, internal to the epigastric artery,
and forces directly forwards through the external abdominal ring,
carrying investments from each of such structures as it meets with in
this locality of the groin. As the external ring, H, Plate 34, is
opposite the inner peritonaeal fossa, Q R, Plate 32, this hernia, which
protrudes thus immediately from behind forwards, is also named direct.
In this way these two varieties of hernia, (the external, Plate 33, and
the internal, Plate 34,) though commencing in different situations, P
and R, Plate 32, within the abdomen, arrive at the same place--viz., the
external ring, H, Plates 33 and 34. The coverings of the internal
hernia, Plate 34, though not derived exactly from the same locality as
those which invest the cord and the external variety, are, nevertheless,
but different parts of the same structures; these are, 1st, the
peritonaeum, G, which forms its sac; 2nd, the pubic part of the fascia
transversalis; 3rd, the conjoined tendon itself, or (according as the
hernia may occur further from the mesial line) the cremaster, which, in
common with the internal oblique and transverse muscles, terminates in
this tendon; 4th, the external spermatic fascia, derived from the
margins of the external ring; 5th, the superficial fascia and
integuments.
The coverings of the internal inguinal hernia are (as to number)
variously described by authors. Thus with respect to the conjoined
tendon, the hernia is said, in some instances, to take an investment of
this structure; in others, to pass through a cleft in its fibres; in
others, to escape by its outer margin. Again, the cremaster muscle is
stated by some to cover this hernia; by others, to be rarely met with,
as forming one of its coverings; and by others, never. Lastly, it is
doubted by some whether this hernia is even covered by a protrusion of
the fascia transversalis in all instances. [Footnote]
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