the hernia progresses down the femoral canal, it pushes ahead of itself the weak fascia of the femoral (crural) septum (which normally occludes the femoral ring) and also the femoral sheath.

The contents of the sac vary greatly. Omentum and small intestine are the structures most frequently encountered, but colon, bladder, fallopian tubes, ovaries, and other normally intra-abdominal viscera have been found in uncommon instances. In some patients, the sac may be empty. Rather frequently encountered is a cystic accumulation of fluid forming a hydrocele because the neck of the sac has become obliterated. [17]

A femoral hernia protruding into the subcutaneous tissue of the thigh is covered by the following layers:

1. Skin and subcutaneous fat

2. Superficial fascia (Camper's) of the thigh with its contained vessels and nerves

3. Outer (anterior) and inner (posterior) portions of the femoral sheath, which are continuations of the internal investing fascia of the abdominal and pelvic musculature; the former is derived from the transversalis fascia, and the latter from the retroperitoneal iliac fascia.

4. The serous sac, which is a diverticular process of the peritoneum containing a space that is continuous with the peritoneal cavity

5. The contents of the sac

The structures Involved In operations for femoral hernia by the direct subinguinal approach are the superficial

Figure 11-1 Levels in the dissection of the inguinofemoral region. A, The relations of the fossa ovalis to the deep fascia of the thigh, the inguinal ligament, and the superficial vessels. B, The fossa ovalis cleared of the lymphatic contents and the cribriform fascia. C, Exposure of the contents of the femoral trigone (of Scarpa) after all superficial structures and the deep fascia have been removed.

Figure 11-2 Contents of the femoral arch viewed from the thigh.

V» fetnopilij An nut us femora lis

Figure 11-2 Contents of the femoral arch viewed from the thigh.

M. i'luusoas ligament im inguinale (Pouparli) N. femoralis A. fern oralis

V» fetnopilij An nut us femora lis

Ugnmcntum lacunars (Gimbernati) Nt. pectiiveus

Tuberculurn [jubtcutn

Figure 11-3 Contents of the left femoral arch viewed from within the pelvis.

M. iliopsoas Spin:» iliaca anterior superior

Antiulus fcmnritHii ; Ligamentum pubaeuui (Cnqpd)

Annuliw inguinal is subcuLaneu*

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