what is an inguinal region?
region that extends between ASIS and Pubic tubercle
significance of inguinal region
- region where structures enter and exit abdominopelvic cavity
- clinically: site for hernia because of the pathways and inlet and exit are sites of herniation
what is an inguinal canal
- oblique intermuscular passage in the inguinal region, 4 cm long in adult in males and also related to testicular development
- it lies parralel superior to the medial half of inguinal ligament
- directed downward and medially
main contents of inguinal canal
spermatic cord for males
round ligament of uteres for females
what are is the nerve presented in inguinal canal
illioinguinal canal
inguinal canal connects to opening:
- deep internal inguinal ring (defect in transversalis fascia), located half inch above inguinal ligament. (lateral to the inferior epigastric vessels)
- superficial (external) inguinal ring, a split that occurs in the external oblique apeneurosis, superiolateral to pubic tubercle
these openings are weak and contribute to hernias
boundaries of the inguinal canal
conjoint tendon, inferior epigastric arteries & vein, reflected inguinal ligament, aponeurosis of external and internal oblique & transversus abdominis
- Posterior wall: formed by Transversalis fascia; conjoint tendon and reflected part of the inguinal ligament.
- Anterior wall: formed by external oblique aponeurosis throughout the length of the canal and by the fibers of the internal oblique at the lateral part
- Roof: formed by arched fibers of the internal obliques and transversus abdominis muscles
- Floor: formed mainly by the inguinal ligament and illiopubic tract
mechanism of inguinal canal
shutter mechanism
flap valve mechanism
ball valve mechanism
slit valve mechanism
protection of superior inguinal ring posteriorly by conjoint tendon and reflected inguinal ligament
Types of hernias
inguinal hernia and femoral hernia
inguinal hernia
occurs above and lateral to pubic tubercle
- direct hernia
- indirect hernia
Direct inguinal hernia
site: inguinal triangle → conjoint tendon→ inguinal canal (doesn’t typically descend to scrotum)
it is acquired
the sac around it is from the peritoneum and transversalis fascia
indirect inguinal hernia
site: deep inguinal ring → superficial ring →scrotal sac
occurs lateral to inferior epigastric
congenital
covered by peritoneum and coverings of the spermatic cord
femoral hernia
occur below and medial to the pubic tubercle
common in females
hernia complications
irreducibility
obstruction
strangulation in gangrene (tissue death due to lack of blood supply)
deep inguinal test
to differentiate between direct and indirect hernia
