The third inguinal ring

Abstract

(1) The superficial fasciae of the groin and perineal regions have been investigated. in great detail in the male subject from foetal life to old age. (2) Certain hitherto unsuspected anatomical features of great practical importance have been disclosed by the research, particularly in regard to the fasciae of Scarpa and of Colles . (3) An undescribed layer of fascia in the perineum has been named the deep fascia of the perineum. (4) The complicated method whereby the scrotum is slung is analysed in detail and serves to throw some light on the cause of the inequality in rate of growth of hernia. (5) Certain fasciai pockets exist e in the perineum and groin in a large percentage of cases. These pockets are proportionately. better marked in the foetus than in the adult. (6) A third orifice is described in the inguinal region which has been named the third: in uinal riz . This presents the form of. a ring in 5O of cases, and the shape of a funnel in the remaining cases. it is of vast importance in connection with imperfect .descent of the testis. It is easily felt clinically. (7) No evidence has been forthcoming in this research which lends the least support to:- (a) the supposed+"excavating" function of the guberna:ulum, (b) the +traction" function of this band, (c) the existence of the gubernacular tails of Lockwood, (8) It is shown that the spermatic cord lies as a rule 1/2" lateral to the pubic tubercle and not medial to it, (9) Extravasation of urine is shown to extend largely as an infiltration of the superficial fasciae rather than as an extravasation deep to them, (104 Femoral hernia may emerge above or below the attachment of .Scarpa's fascia in the groin. The size of the hernia and the direction it takes may be dependent on its relationship to this fascia. (ii) The literature of imperfect extra-abdominal testicular descent is reviewed, (12) A new explanation of this imperfection is put forward, It is based on anatomical findings and may fittingly be called the "anatomical explanation'', Partial descent and ectopia are due to one or more of the following factors (a) congenital anomalies or absence of the third ring. (b) congenital fasci.al pockets. (c) congenital fascial ridges. It is impossible to exclude as further possible causes such factors as shortness of the mesoblastic elements of the cord, or adhesions. It is however pointed out that such occurrences may be secondary and not primary. (13) The anatomical explanation of the various types of ectopies is entered into in considerable detail, and the genesis is explained.