In the female the canal of Nuck is a matter of minor importance, containing only the round ligament. Nevertheless along it may proceed an indirect inguinal hernia corresponding to that in the male.
The so-called acquired indirect hernia, according to the above views, would not occur were it not for the opportunity—as it were, the temptation—already afforded by some deviation of the peritoneal arrangement in this locality. In these cases, however, the sac appears to be new and is pushed along the inguinal canal anteriorly to its normal contents. This may be the result of violent strain, or of one which is apparently disproportionately small, but frequently repeated.
Direct inguinal hernia is generally an occurrence of adult life, takes place commonly as the result of accident, is a direct protrusion through the abdominal wall at the triangular weak spot, whose outer limit is the deep epigastric artery, with the obliterated hypogastric artery to the inner side and Poupart’s ligament below, i. e., the so-called triangle of Hesselbach. This hernia appears always at the external ring, from which it may descend and become scrotal.
Fig. 605
Scrotal hernia. (Richardson.)
With complete or scrotal hernia there is usually little difficulty of diagnosis ([Fig. 605]). An incomplete hernia, protruding at the external ring, covered with considerable fat, and perhaps shifted a little in position, is sometimes hard to distinguish from a hernia through the femoral opening. The inguinal form escapes above Poupart’s ligament, the femoral always below it, and Poupart’s ligament is to be located by a line drawn from the anterior superior spine to the spine of the pubis. The inguinal forms are usually nearer the middle line. If the epigastric artery can be identified, either before or during operation, the character of the hernia will be promptly demonstrated by its relations to the neck of the sac.
Hernial protrusions give a familiar impulse on coughing unless the incarceration of an epiplocele may mask this feature. By it they are to be distinguished from hydrocele, varicocele, aneurysm, undescended testicle, and the like.
Fig. 606
