0. Chiari has contributed a paper on this form of tumor in the ingui nal canal, and also explained the relation of surrounding inflammations to the same. He quotes three cases from Dumreicher's clinic, which on account of the importance of the subject, we will briefly recapitula'e.
In the first case a woman aged sixty noticed six months previously a tumor the size of a nut in the right inguinal region, which, three weeks before she was seen, suddenly increased to the size of an apple. When entering the clinic there was found a club-shaped swelling 21- inches in length, at the upper part about 3f inches broad, and at the lower part to one inch, extending from the right inguinal region to the lower portion of the labium majus. The overlying skin was red and swollen, and the most prominent part was tympanitic. After opening layer by layer, a large quantity of putrid pus and gas escaped. In the deeper part a nut sized sac with a small opening in the anterior wall was found, communi cating with the abdominal cavity by a fistulous opening.
In the second case a woman aged forty-five noticed for four years, in the left inguinal region, a swelling which was always easily reducible. Later it became the size of a goose-egg, very painful, irreducible and situated in the upper part of the labium majus; on account of great pain, constipation, and nausea she came to the clinic. As there was vomiting she was operated upon. A cavity was found filled with serous fluid containing septa, and ending in a blind duct 1 of an inch in the inguinal canal.
In the third case a pigeon-egg-sized swelling in the right inguinal region was produced six weeks previously, by lifting a heavy weight. On account of great pain in the swelling, and nausea, she came to the clinic. She was operated upon on the suppOsition that she had a strangulated hernia, and a longitudinal sac was found, which was separated into an upper and lower portion by a partition that was indicated by a groove, on the outside. Both parts contained a yellow purulent fluid, and were lined by a mucoid, velvety, fringed, highly injected membrane.
All the three women recovered.
0. Chiari cites several similar cases, in which Chassaignac and Piths made incisions for supposed hernial sacs, and obviously found nothing besides the remnants of the diverticulum of Nuck around which inflam mation and suppuration had taken place.
Blob states the origin of these cystic cavities of the inguinal canal to be as follows: If the assumption of E. H. Weber is correct, there would be two possible origins for the so-called sacculated hydrocele or cyst. Weber asserts that the gubernaculum Hunteri (later the round ligament) is originally a hollow pouch surrounded by muscular fibres, deficient involution of which may give rise to a cyst of the round ligament. The other mode of origin of this variety of cysts, consists in an excessive development of the processus vaginalis peritonei, which is follosed by either partial or no involution at all at the internal abdominal ring, leaving a space in the inguinal canal or at its opening, surrounded by peritoneum. This would explain the anatomical relation of these cysts to the round ligament, as described by Blob.
In the course of the round ligament, usually at the internal abdominal ring, thin-walled serous cysts, from the size of a pea to a hazel-nut, are found, and the relation of the round ligament to them varies. Either the round ligament is situated in the wall of the cyst, usually posteriorly or to the inner side, so that it can be seen through the wall of the same as a whitish or yellowish red cord, or it is entirely obscured by the cyst, so that it appears as if it were interrupted. Blob mentions two remark able cases where herniotomy had been performed, and where only hydrocele famine cystica existed.
The cystic cavities continuous with the processus vaginalis, and com municating with the abdominal cavity are called by Blob hydrocele peri tonealis or congenita. Hennig also saw a case of hydroeele produced through an opening in Gimbernat's ligament, and called it hydrocele muliebris interna.
Bends has differentiated three kinds of hydrocele in the external geni tals of the female, which anatomically and pathologically correspond to those of the male. 1. Hydrocele or diffusa, which is a serous infiltration into the connective tissue of the round ligaments. 2. Ily drocele peritonealis or congenita, which is a collection of fluid in the diver ticulum of Nuck. 3. Hydrocele saccata, which is fluid in a closed sac, either a new formation or arising from an abnormal prolongation of the peritoneum.