The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . and sometimes even ascending to some distanceupon the anterior abdominal wall. In the descent of the hernia throughthis course, it first of all pushes before it the peritoneal sac, and thenreceives an investment of the subserous areolar tissue—the septumerurale, a mass of dense areolar tissue, containing fat and lymphatics,occupying the crural ring. This septum often becomes incorporatedand matted with the contiguous portion of the sheath, thus constituting FEMOEAL HERNIA. 643 the fascia propria
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . and sometimes even ascending to some distanceupon the anterior abdominal wall. In the descent of the hernia throughthis course, it first of all pushes before it the peritoneal sac, and thenreceives an investment of the subserous areolar tissue—the septumerurale, a mass of dense areolar tissue, containing fat and lymphatics,occupying the crural ring. This septum often becomes incorporatedand matted with the contiguous portion of the sheath, thus constituting FEMOEAL HERNIA. 643 the fascia propria of this hernia, which is commonly thickened, lami-nated, and of an opaque fatty structure, like omentum. As the herniacontinues to descend, it comes into relation with the cribriform fascia,which occupies the saphenous opening, and, lastly, pushes before it theintegumental structures. As the tumor descends through this course, it necessarily comes intorelation with very important parts (Fig. 688). Thus it is separated fromthe femoral vein solely by the septum of the sheath of the vessels. It. Fig. 68S.—1. Femoral Hei-nia: 2. Femoral Vein; 3. Femoral Artery, giviasj off, 4, Commoa Trunk ofEpigastric and Obturator Arteries, and 5, Epigastric Artery ; 6, Spermatic Cord. has the epigastric artery above and to its outer side; and the spermaticcord in the male, or the round ligament in the female, almost imme-diately above it. The obturator artery, when arising in the normalmanner from the internal iliac, does not come into relation with theneck of the sac; but when it takes its origin, as it not unfrequentlydoes, from the external iliac, the common femoral, or the epigastric, itmay have important relations to this part of the hernia. Most com-monly, in these circumstances, it passes to the iliac or outer side of theneck, but occasionally it winds round its inner or pubic side, coraino-into rather close relation with it; and then, as will immediately be men-tioned, it may be in c
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