Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
PLATE 41, Fig. 8.--When the serous spermatic tube only closes at the
internal ring, as seen at 1, Fig. 4, Plate 41, if a hernia afterwards
pouch the peritonaeum at this part, and enter the inguinal canal, we
shall then have the form of hernia, Fig. 8, Plate 41, termed infantile.
Two serous sacs will be here found, one within the cord, 13, and
communicating with the tunica vaginalis, the other, 11, containing the
bowel, and being received by inversion into the upper extremity of the
first. Thus the infantile serous canal, 13, receives the hernial sac,
11. The inguinal canal and cord may become multicapsular, as in Fig. 8,
from various causes, each capsule being a distinct serous membrane.
First, independent of hernial formation, the original serous tube may
become interruptedly obliterated, as in Plate 40, Fig. 2. Secondly,
these sacs may persist to adult age, and have a hernial sac added to
their number, whatever this may be. Thirdly, the original serous tube,
13, Fig. 8, may persist, and after having received the hernial sac, 11,
the bowel may have been reduced, leaving its sac behind it in the
inguinal canal; the neck of this sac may have been obliterated by the
pressure of a truss, a second hernia may protrude at the point 1, and
this may be received into the first hernial sac in the same manner as
the first was received into the original serous infantile tube. The
possibility of these occurrences is self-evident, even if they were
never as yet experienced. [Footnote]
[Footnote: According to Mr. Lawrence and M. Cloquet, most of the serous
cysts found around hernial tumours are ancient sacs obliterated at the
neck, and adhering to the new swelling (opera cit.)]
[Illustration: Abdomen, showing bone, blood vessels
and other internal organs.]
Plate 41--Figure 8
PLATE 42, Fig. 1.--The epigastric artery, 9, being covered by the fascia
transversalis, can lend no support to the internal ring, 2, 2, nor to
the tube prolonged from it. The herniary bowel may, therefore, dilate
the peritonaeum immediately on the inner side of the artery, and enter
the inguinal canal. In this way the hernia, 11, although situated
internal to the epigastric artery, assumes an oblique course through the
canal, and thus closely simulates the external variety of inguinal
hernia, Fig. 7, Plate 41. If the hernia enter the canal, as represented
in Fig. 1, Plate 42, it becomes invested by the same structures, and
assumes the same position in respect to the spermatic vessels, as the
external hernia.
[Illustration: Abdomen and scrotum, showing bone, blood vessels
and other internal organs.]
Plate 42--Figure 1
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