Origin of the epigastric and obturator arteries by a common trunk from the internal iliac : with an inquiry into the amount of danger occasioned by various positions of arteries in the ordinary operations for femoral and inguinal hernia / by P. Redfern.

  • Redfern, Peter, 1821-1912.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Origin of the epigastric and obturator arteries by a common trunk from the internal iliac : with an inquiry into the amount of danger occasioned by various positions of arteries in the ordinary operations for femoral and inguinal hernia / by P. Redfern. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    El'ICASTRlC jVJ<D OliTUUATOK AllTEUIES. nal iliac by means of the obturator arismg from the epigastric,—or from the epigastric arteiy. Again, tne intemal circumflex arteiy sometimes arises from the external iliac, the epigastric or obturator; and the epigastric and obturator vessels have oeen found arising from the femoral, the pro- funda femoris, or from the intemal circumflex arteries, and pi’oceed- ing to their destination through the crural canal, in which position a small branch from the epigastric artery will be found in the accom- panying wood-cut. So it appears very generally to be true that varieties in the posi- tion or origin of the larger arteries result from the enlargement of their usual anastomosing branches with other vessels, the artery which occupies the normal position becoming at the same time pro- portionally diminished in its diameter. This is remarkably ex- emplified by the obturator artery, which, in difierent instances, arises from the intemal iliac,—from the epigastric bx'anch of the external iliac, or from the trunk itself,—or again, from both iliac arteries at once, by branches either of equal or of difierent sizes, as has been so beautifully demonstrated by Professor Quain and Mr Maclise; and a few other instances of removal of the epigastric artery from the external iliac, may give as complete an explanation of the manner in which its varieties become developed. However great the interest which is excited by varieties in the position and origin of arteries when viewed physiologically, it can never equal in importance that which they acquire from their sur- gical relations. These are so important, in the case of the epigastric and obturator arteries, that all their varieties have ever been re- gained with peculiar anxiety; and the estimate of the increased amount of danger which they may occasion under various circum- stances yet remains a desideratum. To attain this, it appears necessary, 1st, to review those varieties of position in which a vessel of considerable size appears likely to be exposed to danger in the performance of ordinary operations, and, if possible, to ascertain the frequency of like positions; 2nd, to inquire in what proportion of such operations vessels of importance have been injured in actual practice; and, 3d, to determine the probable result of future cases of injury of these vessels, by a reference to the termination of those which have already been made public. In what follows, these inquiries will be pursued as far as our present imperfect data will warrant, and they will be limited to those arteries which may pos- sibly be endangered by the ordinary operations for inguinal and i femoral hernia. ■\ Inguinal Hernia.—The epigastric artery has a remarkably con- I stant position in all the various forms of inguinal hernia, lying on the inner side of the internal abdominal ring and the neck of an oblique hernia, and to the outer side of the neck of the sac of both superior and inferior direct hei-nia;. To this general rule there ap- B I