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K DEVI SANKAR, Assistant Professor of Anatomy, Narayana Medical College, Nellore, Andhra Pradesh, India

Musculo-aponeurotic canal.

4cm long.
Extends from deep inguinal ring (lateral) to superficial inguinal ring (medial). Directed medially. inferiorly, anteriorly and

Present above and parallel to medial half of inguinal ligament. The canal is narrow in females and almost straight anteriorly in infants because of underdeveloped abdominal wall muscles.

ANTERIOR

External oblique aponeurosis


Lateral 1/3 of canal reinforced by internal oblique muscle fibers.

POSTERIOR
Entirely by fascia transversalis Medial 1/3 reinforced by conjoint tendon infront of fascia transversalis Reflected part of inguinal infront of conjoined tendon. ligament

ROOF Arched fibers of internal oblique and transversus abdominis muscles.

FLOOR Grooved ligament Medially ligament upper is surface of with Inguinal lacunar

continuous

Gives attachment to fascia lata on the inferior border

LATERAL Deep inguinal ring

Opening in fascia transversalis


1 cm above the inguinal ligament Midway between anterior superior iliac spine and symphysis pubis Medial to it lie the Inferior Epigastric vessels

MEDIAL Superficial inguinal ring

Triangular defect aponeurosis

in

external

oblique

Overlies the pubic crest which forms the base of the opening

CONTENTS OF INGUINAL CANAL Spermatic cord and ilioinguinal nerve in males Round ligament of uterus and ilioinguinal nerve in females

COVERINGS OF SPERMATIC CORD

Each anterior abdominal wall layer gives covering to spermatic cord. From within outwards the coverings are derived as follows,
Internal Spermatic fascia from fascia transversalis Cremasteric oblique fascia from internal

External spermatic external oblique

fascia

from

CONTENTS OF SPERMATIC CORD


1) Vas deferens 2) Artery to vas deferens (branch of inferior vesicle artery) 3) Testicular artery (branch of abdominal aorta) 4) Testicular vein 5) Testicular lymphatics 6) Testicular nerve fibers 7) Processus vaginalis (inconstant) 8) Cremasteric artery (branch of inferior epigastric artery) 9) Nerve to cremaster (genital branch of genitofemoral nerve)

SPERMATIC CORD & ITS CONTENTS


Cremasteric nerve and vessels
External spermatic fascia

Cremasteric fascia Internal spermatic fascia Testicular artery, Pampiniform plexus of veins and Sympathetics Vas deferens surrounded by lymphatics

Ilio-inguinal nerve

Boundaries:

HESSELBACHS TRIANGLE

Medial half of inguinal ligament

Linea semilunaris (lateral border of rectus abdominis)


Inferior epigastric artery Surgical importance: Not reinforced by conjoint tendon

Potentially weak area


Direct Inguinal through it hernias protrude

Inguinal Hernia

A hernia is a condition in which part of the intestine bulges through a weak area in muscles in the abdomen. An inguinal hernia occurs in the groin (the area between the abdomen and thigh). It is called "inguinal" because the intestines push through a weak spot in the inguinal canal.

FACTORS

Obesity, pregnancy, heavy lifting, and straining to pass stool can cause the intestine to push against the inguinal canal.

A SPLIT IN THE SIDEWALL OF AN EXCAVATOR TYRE ALLOWS THE INNER TUBE TO PROTRUDE

A hernia is similar to the failure of a tyre

Symptoms of inguinal hernia may include a lump in the groin near the thigh; pain in the groin; and, in severe cases, partial or complete blockage of the intestine. The main treatment for inguinal hernia is surgery to repair the opening in the muscle wall. This surgery is called herniorrhaphy.

TYPES OF INGUINAL HERNIA Inguinal hernias are further divided into the more common indirect inguinal hernia, in which the abdominal content is entered into IC via a congenital weakness at its entrance (the deep inguinal ring). In direct inguinal hernia, where the hernia contents push through a weak spot in the posterior wall of the inguinal canal, lateral to conjoint tendon.

Direct inguinal hernia (DIH) passes through Hesselbachs triangle. The triangle is divided into medial and lateral part by obliterated umbilical artery. So the DIH is divided into medial (MDIH) and lateral (LDIH)

DIH occurs mostly in old age (after 75 years)


Frequently bilateral and incomplete

O U A

COVERINGS OF MDIH (from in to outside)

Extra-peritoneal tissue
Fascia transversalis Conjoined tendon External spermatic fascia skin

COVERINGS OF LDIH (from in to outside)

Extra-peritoneal tissue
Fascia transversalis

Cremasteric fascia
External spermatic fascia skin

Indirect inguinal hernia (IDIH) mainly in males; weakness produced during descent of testis TYPES OF IDIH
CONGENITAL VAGINAL HERNIA processus vaginalis present in hernia content . (PV is a peritoneum running along with testis during its descent. Later it disappears but sometime persists)

BUBONOCELE conformed hernia through inguinal canal and does not protrude through the superficial inguinal ring

COVERINGS OF IDIH (from in to outside)


Extra-peritoneal tissue

Internal spermatic fascia


Cremasteric fascia

External spermatic fascia


skin

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