. American practice of surgery ; a complete system of the science and art of surgery . and they may disappear on pressure or on change of posture, they are not rarely mistaken for irreducible hernia. Severalcases have come under our observation in which trusses were placed upon suchswellings. The differential diagnosis can always be made by testing the ex-tension of the hip. Limitation of extension is an early and marked symptomin lumbar abscesses due to spondylitis or other causes associated with the psoasand iliacus muscles. Atypical Forms of Femoral Hernia.—While the ordinary r
. American practice of surgery ; a complete system of the science and art of surgery . and they may disappear on pressure or on change of posture, they are not rarely mistaken for irreducible hernia. Severalcases have come under our observation in which trusses were placed upon suchswellings. The differential diagnosis can always be made by testing the ex-tension of the hip. Limitation of extension is an early and marked symptomin lumbar abscesses due to spondylitis or other causes associated with the psoasand iliacus muscles. Atypical Forms of Femoral Hernia.—While the ordinary route of a femoralhernia is internal to the great vessels, the bowel may exceptionally pass downexternally to the sheath of the femoral artery. This anomalous form has beencalled external femoral hernia by Bahr (1898), and cases have been reportedby Mcllvane, Narrath, Fabricius, Clocjuet, and Axhausen. The route of thesehernias is between the ileopectineal ligament (see above) and the femoral artery,at w^hich point the anatomical studies of Leinhart show that a weak place Fig. 226.—The Bassini-Fournel Oper-ation, Identical with the Girard and theAndrews Operations. {From Bouveret.) 588 AMERICAN PRACTICE OF SURGERY. The very obli(iue direction of this ligament from Pouparts ligament backwardleaves a triangular space, wider in front, which is somewhat unsupported inthe immediate vicinity of the vessel sheath. (Fig. 237.) Hesselbach, Sr.,describes bands which pass from the anterior iliacus sheath to the transversalisfascia and crural arch, forming a sort of guide or septum leading toward thisweak point. External femoral hernia may occur in three forms correspond-ing to the routes taken by the escaping bowel: (1) Outside the great vessels;(2) alongside the deep epigastric vessels; (3) alongside the muscle behind thevessels. (Fig. 238.) Maydl also describes a still rarer form which makes itsway inside the vessel sheaths. Treatment of Femoral Hernia.—Operative treatment
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