Surgical Anatomy Part 27

PLATE 32.

A. That part of the ilium which abuts against the sacrum.

B. The spine of the ischium.

C. The tuberosity of the ischium.

D. The symphysis pubis.

E. Situation of the anterior superior iliac spine.

F. Crest of the ilium.

G. Iliacus muscle.

H. Psoas magnus muscle supporting the spermatic vessels.

I. Transversalis muscle.

K. Termination of the sheath of the rectus muscle.

L1 L2 L3. The iliac, transverse and pelvic portions of the transversalis fascia.

M M. The peritonaeum lining the groin.

N. The epigastric vessels lying between the peritonaeum, M, and the transversalis fascia, L2. O. The umbilical ligament.

P. The neck of the sac of an external inguinal hernia formed before the spermatic vessels.

Q. An interval which occasionally occurs between the umbilical ligament and the epigastric artery.

R and Q. Situations where the direct inguinal hernia occurs when, as in this case, the umbilical ligament crosses the s.p.a.ce named the internal fossa--the triangle of Hesselbach.

S. Lower part of the right spermatic cord.

T. The bulb of the urethra.

U. External iliac vein covered by the peritonaeum.

V. External iliac artery covered by the peritonaeum.

W. Internal iliac artery.

X. Common iliac artery.

[Ill.u.s.tration: Abdomen, showing bones, blood vessels, muscles and other internal organs.]

Plate 32

PLATE 33.--The External Inguinal Hernia.

A. Anterior iliac spinous process.

B. The umbilicus.

C. Fleshy part of the external oblique muscle; c, its tendon.

D. Fleshy part of the internal oblique muscle; d, its tendon.

E. Transversalis muscle; e, the conjoined tendon.

F f. The funnel-shaped sheath of the spermatic vessels covering the external hernia; upon it are seen the cremasteric fibres.

G g. The peritonaeal covering or sac of the external hernia within the sheath.

H. The external abdominal ring.

I. The crista pubis.

K k. The saphenous opening.

L. The saphena vein.

M. The femoral vein.

N. The femoral artery; n, its profunda branch.

O. The anterior crural nerve.

P. The epigastric vessels overlaid by the neck of the hernia.

Q Q. The sheath of the femoral vessels.

R. The sartorius muscle.

S. The iliacus muscle.

[Ill.u.s.tration: Abdomen and leg, showing blood vessels, muscles and other internal organs.]

Plate 33

PLATE 34.--The Internal Inguinal Hernia.

The letters indicate the same parts as in Plate 33

[Ill.u.s.tration: Abdomen and leg, showing blood vessels, muscles and other internal organs.]