Download MBBS Anatomy PPT 65 Inguinal Canal Notes

Inguinal canal

2.2.6 Inguinal area

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Surface anatomy

Inguinal Canal

? It is an oblique intermuscular passage through the lower

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part of the anterior abdominal wall

? Present in both sexes

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? It allows structures to pass to and from the testis to the

abdomen in males

? In females it permits the passage of the round ligament

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of the uterus from the uterus to the labium majus

? Transmits ilioinguinal nerve in both sexes

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Inguinal Canal

? It is about 1 ? inches or 4cm long in the adults

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? 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

? In the newborn child, the deep ring lies almost

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directly posterior to the superficial ring

Deep Inguinal Ring

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? Is an oval opening in the fascia

transversalis

? Lies about ? inch (1.3cm) above the

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inguinal ligament midway between the

anterosuperior iliac spine and the

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symphysis pubis

? Margins of the ring give attachment to the

internal spermatic fascia

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Superficial 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 the

pubic tubercle

? Its margins give attachment to the external

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spermatic fascia

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Anterior Wal of Inguinal Canal

? 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 the

origin of the internal oblique from the

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inguinal ligament

? This wall is strongest where it lies opposite

the weakest part of posterior wall, that is

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deep inguinal ring

Posterior Wal of Inguinal Canal

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? Is formed along its entire length by the fascia

transversalis

? It is reinforced in its medial third by conjoint

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tendon, the common tendon of insertion of

internal oblique and transversus, attached to the

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pubic crest and pectineal line

? This wall is strongest where it lies opposite the

weakest part of the anterior wall, that is

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superficial inguinal ring

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Inferior Wal of Inguinal Canal

? Is formed by the rolled-under inferior edge

of the aponeurosis of the external oblique

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muscle called inguinal ligament and at its

medial end, the lacunar ligament

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Superior Wal of Inguinal

Canal

? Is formed by the arching lowest fibers of

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the internal oblique and transversus

abdominis muscles
Functions of Inguinal Canal

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? It allows structures of spermatic cord to

pass to and from the testis to the abdomen

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in male

? Permits the passage of round ligament of

uterus from the uterus to the labium majus

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in female

Mechanics of Inguinal Canal

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? Flap valve mechanish- oblique canal,

deep & sup. Ing ring do not lie opposite to

each other- increased intra abdo pressure

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? ant & post wall are approximated like a

flap.

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? Guarding of the inguinal rings- deep ing

ring guarded ANTERIORLY by IOM, Sup.

Ing ring guarded posteriorly ? conjoint

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tendon & reflected part of ing lig.
Mechanics of Inguinal Canal

? Shutter Mechanism- IOM surrounds the

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canal in front, above & behind like a

flexible mobile arch. When it contracts roof

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is pulled & approximated on the floor like a

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

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also help.

Mechanics of Inguinal Canal

? Ball valve Mechanism-

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contraction of cremaster muscle pulls the

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 the

testis

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? It is covered with three concentric layers of

fascia derived from the layers of anterior

abdominal wall

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? It begins at the deep inguinal ring lateral to

the inferior epigastric artery and ends at

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the testis


2.2.6 Inguinal area

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Spermatic cord

? 3 Fascia layers

3 Nerves

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Genito-femoral nerve

l External spermatic

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fascia

Ilio-inguinal nerve

Sympathetic

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l Cremasteric fascia

autonomic plexus

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l Internal speratic fascia 3 Other structures

? 3 Arteries

Lymphatic vessels

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Ductus deferens

l Testicular artery

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Pampiniform venous

l Cremasteric artery

plexus

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l Artery to ductus

deferens
2.2.6 Inguinal area

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Spermatic cord

Vas Deferens

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? It is a cord like structure

? Can be palpated between finger and

thumb in the upper part of the scrotum

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? It is a thick walled muscular duct that

transport spermatozoa from the epididymis

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to the urethra
Testicular Artery

? It is a branch of abdominal aorta

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? It is long and slender

? Descends on the posterior abdominal wall

? It traverses the inguinal canal and supplies

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the testis and the epididymis

Testicular Veins

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? These are the extensive venous plexus, the

pampiniform plexus

? Leaves the posterior border of the testis

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? As the plexus ascends, it becomes reduced in

size so that at about the level of deep inguinal

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ring, a single testicular vein is formed

? 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

three concentric layers of fascia derived

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from the layers of the anterior abdominal

wall

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? Each covering is acquired as the

processus vaginalis descends into the

scrotum through the layers of the

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abdominal wall

Covering of the Spermatic Cord

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? External Spermatic fascia: Is derived from the

external oblique aponeurosis and attached to the

margins of the superficial inguinal ring

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? 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

of deep inguinal ring

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Inguinal 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 the

layers 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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hernia

abdominal-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 to

adulthood.

? 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 superficial

inguinal 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

of the abdominal wall through which the

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hernial 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

sac contains a Meckel's Diverticulum.

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INGUINAL (HESSELBACH'S)

TRIANGLE

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? INGUINAL (HESSELBACH'S) TRIANGLE is an area of

the anterior abdominal wall bounded by

? Inferior epigastric vessels,

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? Inguinal ligament and
? Lateral border of the rectus abdominis.

? Direct inguinal hernias leave the abdomen through this

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triangle.


? Boundaries
? Medial border: Lateral margin of the rectus

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sheath, also called linea semilunaris

? Superolateral border: Inferior epigastric

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vessels

? Inferior border: Inguinal ligament, sometimes

referred to as Poupart's ligament

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? 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 triangle
Two types of inguinal hernia

l

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DIRECT AND

l

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 of

the 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 time

for 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,

the sac that holds the testicles

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? 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

weakness into the inguinal canal, causing a hernia.

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? 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.

?

Common in old men with weak abdominal

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muscles and rare in women

?

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The neck of the hernial sac is wide

? The hernia involves fat or the small intestine

sliding through the weak muscles into the groin.

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? 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

l lifting heavy objects

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l 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 epigastric

vessels

? 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 the

scrotum 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

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Direct Inguinal Hernia

? 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

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wall of the inguinal canal medial to the inferior

epigastric artery

? The neck of the hernial sac is wide

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