Surface anatomy
Inguinal Canal
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? It is an oblique intermuscular passage through the lower
part of the anterior abdominal wall
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? Present in both sexes? It allows structures to pass to and from the testis to the
abdomen in males
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? In females it permits the passage of the round ligament
of the uterus from the uterus to the labium majus
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? Transmits ilioinguinal nerve in both sexesInguinal Canal
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? It is about 1 ? inches or 4cm long in the adults? Extends from the deep inguinal ring downward
and medially to the superficial inguinal ring
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? Lies parallel to and immediately above the
inguinal ligament
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? In the newborn child, the deep ring lies almostdirectly posterior to the superficial ring
Deep Inguinal Ring
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? Is an oval opening in the fascia
transversalis
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? Lies about ? inch (1.3cm) above theinguinal ligament midway between the
anterosuperior iliac spine and the
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symphysis pubis
? Margins of the ring give attachment to the
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internal spermatic fasciaSuperficial Inguinal Ring
? Is triangular in shape
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? Lies in the aponeurosis of the external
oblique muscle
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? Lies immediately above and medial to thepubic tubercle
? Its margins give attachment to the external
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spermatic fascia
Anterior Wal of Inguinal Canal
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? Is formed along its entire length by
aponeurosis of the external oblique muscle
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? It is reinforced in its lateral third by theorigin of the internal oblique from the
inguinal ligament
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? This wall is strongest where it lies opposite
the weakest part of posterior wall, that is
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deep inguinal ringPosterior Wal of Inguinal Canal
? Is formed along its entire length by the fascia
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transversalis
? It is reinforced in its medial third by conjoint
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tendon, the common tendon of insertion ofinternal oblique and transversus, attached to the
pubic crest and pectineal line
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? This wall is strongest where it lies opposite the
weakest part of the anterior wall, that is
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superficial inguinal ringInferior Wal of Inguinal Canal
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? Is formed by the rolled-under inferior edgeof the aponeurosis of the external oblique
muscle called inguinal ligament and at its
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medial end, the lacunar ligament
Superior Wal of Inguinal
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Canal? Is formed by the arching lowest fibers of
the internal oblique and transversus
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abdominis muscles
Functions of Inguinal Canal
? It allows structures of spermatic cord to
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pass to and from the testis to the abdomen
in male
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? Permits the passage of round ligament ofuterus from the uterus to the labium majus
in female
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Mechanics of Inguinal Canal
? Flap valve mechanish- oblique canal,
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deep & sup. Ing ring do not lie opposite toeach other- increased intra abdo pressure
? ant & post wall are approximated like a
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flap.
? Guarding of the inguinal rings- deep ing
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ring guarded ANTERIORLY by IOM, Sup.Ing ring guarded posteriorly ? conjoint
tendon & reflected part of ing lig.
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Mechanics of Inguinal Canal
? Shutter Mechanism- IOM surrounds the
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canal in front, above & behind like aflexible mobile arch. When it contracts roof
is pulled & approximated on the floor like a
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shutter
? slit- valve mechanism- contraction of EOM
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approximates the two crura of sup ing.Ring like a slit valve , the intercrural fibers
also help.
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Mechanics of Inguinal Canal
? Ball valve Mechanism-
contraction of cremaster muscle pulls the
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testis up & sup. Ing. Ring is plugged by
spermat. Cord.
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Spermatic Cord
? It is a collection of structures that pass
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through the inguinal canal to and from thetestis
? It is covered with three concentric layers of
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fascia derived from the layers of anterior
abdominal wall
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? It begins at the deep inguinal ring lateral tothe inferior epigastric artery and ends at
the testis
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2.2.6 Inguinal area
Spermatic cord
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? 3 Fascia layers3 Nerves
Genito-femoral nerve
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l External spermatic
fascia
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Ilio-inguinal nerveSympathetic
l Cremasteric fascia
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autonomic plexus
l Internal speratic fascia 3 Other structures
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? 3 ArteriesLymphatic vessels
Ductus deferens
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l Testicular artery
Pampiniform venous
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l Cremasteric arteryplexus
l Artery to ductus
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deferens
2.2.6 Inguinal area
Spermatic cord
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Vas Deferens
? It is a cord like structure
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? Can be palpated between finger andthumb in the upper part of the scrotum
? It is a thick walled muscular duct that
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transport spermatozoa from the epididymis
to the urethra
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Testicular Artery? It is a branch of abdominal aorta
? It is long and slender
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? Descends on the posterior abdominal wall
? It traverses the inguinal canal and supplies
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the testis and the epididymisTesticular Veins
? These are the extensive venous plexus, the
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pampiniform plexus
? Leaves the posterior border of the testis
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? As the plexus ascends, it becomes reduced insize so that at about the level of deep inguinal
ring, a single testicular vein is formed
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? Drains into left renal vein on left side and inferior
vena cava on right side
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Covering of the Spermatic Cord
? The covering of the spermatic cord are
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three concentric layers of fascia derivedfrom the layers of the anterior abdominal
wall
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? Each covering is acquired as the
processus vaginalis descends into the
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scrotum through the layers of theabdominal wall
Covering of the Spermatic Cord
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? External Spermatic fascia: Is derived from the
external oblique aponeurosis and attached to the
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margins of the superficial inguinal ring? Cremasteric Fascia: Is derived from the internal
oblique muscle
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? Internal Spermatic Fascia: Is derived from the
fascia transversalis and attached to the margins
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of deep inguinal ringInguinal Hernia
? A hernia is the protrusion of part of the
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abdominal contents beyond the normal
confines of the abdominal wall
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? Hernial coverings are formed from thelayers of the abdominal wall through which
the hernial sac passes
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Inguinal canal
Inguinal
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? An Inguinal hernia is a
protrusion of contents of
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herniaabdominal-cavity through
the Inguinal canal.
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? Bulges through a weak
area in the lower abdominal
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muscles.? An inguinal hernia appears
as a bulge on one or both
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sides of the groin. An
inguinal hernia can occur
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any time from infancy toadulthood.
? Inguinal hernias tend to
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become larger with time.
? More common in males
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? In the case of the female, the opening of the superficialinguinal ring is smaller than that of the male.
? As a result, the possibility for hernias through the
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inguinal canal in males is much greater because they
have a larger opening and therefore a much weaker wall
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for the intestines to protrude through.Parts of hernia
? Consists of four parts: the sac, contents of
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the sac, covering of the sac and neck.
? Hernial coverings are formed from the layers
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of the abdominal wall through which thehernial sac passes.
? In Amyand's hernia, the content of the hernial
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sac is the vermiform appendix.
? In Littre's hernia, the content of the hernial
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sac contains a Meckel's Diverticulum.INGUINAL (HESSELBACH'S)
TRIANGLE
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? INGUINAL (HESSELBACH'S) TRIANGLE is an area of
the anterior abdominal wall bounded by
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? Inferior epigastric vessels,? Inguinal ligament and
? Lateral border of the rectus abdominis.
? Direct inguinal hernias leave the abdomen through this
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triangle.
? Boundaries
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? Medial border: Lateral margin of the rectussheath, also called linea semilunaris
? Superolateral border: Inferior epigastric
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vessels
? Inferior border: Inguinal ligament, sometimes
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referred to as Poupart's ligament? This can be remembered by the mnemonic
RIP (as direct inguinal hernias rip directly
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through the abdominal wall).
2.2.6 Inguinal area
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Hesselbach's triangleTwo types of inguinal hernia
l
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DIRECT ANDl
INDIRECT,
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? which are defined by their relationship to the inferior
epigastric vessels.
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? Direct inguinal hernias occur medial to the inferior epigastric
vessels when abdominal contents herniate through a weak spot
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in the fascia of the posterior wall of the inguinal canal, which is
formed by the transversalis fascia.
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? Indirect inguinal hernias occur when abdominal contents protrude
through the deep inguinal ring, lateral to the inferior epigastric
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vessels; this may be caused by failure of embryonic closure ofthe processus vaginalis.
? Indirect inguinal hernia.
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l Indirect inguinal hernias are congenital hernias.
? More common in males than females
? Indirect hernias are the most common type of
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inguinal hernia.
? More common on right side.
? The neck of the hernial sac lies at the deep
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inguinal ring
? Premature infants are especially at risk for indirect
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inguinal hernias because there is less timefor processus vaginalis to obliterate.
? In a male fetus, the spermatic cord and both testicles--
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starting from an intra-abdominal location--normally
descend through the inguinal canal into the scrotum,
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the sac that holds the testicles? Sometimes the entrance of the inguinal canal at the
inguinal ring does not close as it should just after birth,
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leaving a weakness in the abdominal wall.
? Fat or part of the small intestine slides through the
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weakness into the inguinal canal, causing a hernia.? In females, an indirect inguinal hernia is caused by the
female organs or the small intestine sliding into the
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groin through a weakness in the abdominal wall.
Direct inguinal hernias
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?Caused by connective tissue degeneration of the
abdominal muscles, which causes weakening of
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the muscles.
?
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Common in old men with weak abdominalmuscles and rare in women
?
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The neck of the hernial sac is wide
? The hernia involves fat or the small intestine
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sliding through the weak muscles into the groin.? A direct hernia develops gradually because of
continuous stress on the muscles.
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? One or more of the following factors can cause
pressure on the abdominal muscles and may
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worsen the hernia:
l sudden twists, pulls, or muscle strains
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l lifting heavy objectsl straining on the toilet because of constipation
l weight gain
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l chronic coughing
Indirect Inguinal Hernia
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? It is the most common form of hernia? Is believed to be congenital in origin
? The hernial sac is remains of processus
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vaginalis
? Enters the inguinal canal through the deep
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inguinal ring lateral to the inferior epigastricvessels
? It may extend part of the way along the canal or
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as far as the superficial inguinal ring
Indirect Inguinal Hernia
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? If the processus vaginalis has undergone no
obliteration, the hernia is complete and extends
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through the superficial inguinal ring down into thescrotum or labium majus
? Under these circumstances the neck of the
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hernial sac lies at the deep inguinal ring
? It is 20 times more common in young males than
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females? Is more common on the right side
Direct Inguinal Hernia
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? It composes about 15% of all inguinal hernias
? Common in old men with weak abdominal
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muscles and rare in women? Hernial sac bulges forward through the posterior
wall of the inguinal canal medial to the inferior
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epigastric artery
? The neck of the hernial sac is wide
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