Case of obturator hernia of the ovary / by J. Dunlop Lickley.

  • Lickley, James Dunlop
Date:
[1902]
Catalogue details

Licence: In copyright

Credit: Case of obturator hernia of the ovary / by J. Dunlop Lickley. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    find that there does exist a layer of fascia over the foramen, a layer which is (]uite distinctly defined, althoutjh much tlunner than the tliickened rim with which it is continuous at the lower mai-gin of the ring. This thin layer is pierced by the obturator vessels and nerves, which receive an investment from it as they pass througli the foramen. Most of the other observers who have described cases of obturator hernia have recognised a distinct fascia forming the outer wall of the sac, but have differed somewhat in their interpretation of the nature of this fascia. Labb^,^ for in- stance, describes it as fascia iliaca and fascia pclvien, while much more recently Targett'^ has distinguished it as ohtarator fascia. These differences are, however, probably differences merely in the nomenclature. In the present case, I have adopted the nomenclature of Cleland and Mackay,^ and have described as pelvic fascia, that layer of fascia which is bound down to the iliopectineal line, and is continuous above and externally with the iliac fascia and inferiorly with the recto- vesical fascia. During the formation of the hernia, the fine layer of this fascia, which originally covered the ring, has undergone considerable thickening, and has been carried for- ward as a well marked fascial pouch, separated loosely from the peritoneal sac by a quantity of fat. This pouch can be very easily stripped off from the peritoneum, and its continuity with the pelvic fascia demonstrated. Fredet * has not been able to find this layer of pelvic fascia in his case, but has described as the outer covering of the sac a layer of what he has called umhilico-vesical fascia. This umbilico-vesical fascia is a layer of subperitoneal fascia which passes between the obliterated hypogastric arteries of the two sides across the front of the bladder, and extends up to the umbilicus. This fascia was present here, but as it was with difficulty separable from the peritoneum, I have included it with that sac, regarding it as a specially defined and strengthened subperitoneal tissue. Fredet lays considerable stress on the presence of this covering of the hernia as a means of differentiating the congenital and acquired forms of obturator hernia from one another. He believes that the umbilico-vesical fascia is formed by the approximation and fusion of two adjacent 1 Labb($, Bull. Soc. Imp. de Chir., Paris, 1866. 2 Targett, case reported by Sinigar, British Medical Journal, 6th March, 1897. 3 Cleland and Mackay, Anatomy, General and Descriptive, 1896. ■* Fredet, loc. cit.