Download Abdominal Wall (2): Inguinal Region

Abdominal Wall (2):
Inguinal Region
Inguinal Region
The inf. part of anterolateral
abdominal wall
Area of weakness:
Passage of spermatic cord
through a canal (inguinal)
Inguinal Canal
Superior & parallel to medial ½ of
inguinal ligament
Runs oblique in inferomedial direction
Contents
1:
Male: spermatic cord
Female: round lig. of uterus
2: ilioinguinal n. (L1)
Openings of Inguinal Canal
Deep inguinal ring (Internal):
entrance to the canal
above the middle of inguinal ligament
Oval opening in transversalis fascia
Superficial inguinal ring:
Triangular exit
Due to defect in ???
Lateral & Medial (margins) Borders  crura
Crura: attachment site for external fascia
covering the spermatic cord
Walls of the canal
Anterior:
External oblique aponeurosis
reinforced on lat. 1/3 by:
Internal oblique m.
Posterior:
Transversalis fascia
Reinforced medially by:
Insertion of int. oblique &
transversus m. (Conjoint tendon)
Conjoint Tendon
Merging of internal oblique aponeurosis & transversus abdominis
aponeurosis to share a common insertion into pubic crest
Located
posteromedial to
superficial ring
Walls of Inguinal Canal
Roof:
arching fibers of Internal oblique m. & Transversus m.
Walls of Inguinal Canal
Floor:
Inguinal Ligament
& Lacunar lig.
Lacunar Lig.:
medial continuation of inguinal
ligament
Lacunar Lig.: a small part of inguinal ligament fibers that reflected
from pubic tubercle & attach to the pubic ramus
Lacunar Ligament
M - muscles
A - aponeuroses
L - ligaments
T - transversalis/tendon
Conjoint Tendon?
Lacunar Lig.?
Spermatic Cord
Spermatic Cord
Contents
Ductus (vas) deferens
Testicular artery
a. to vas deferns
Cremasteric a.
Testicular Vein (pampiniform plexus)
Autonomic nerve fibers
Genital branch of genitofemoral n.
(to cremaster muscle)
Lymphatic vessels
Cremaster Muscle
(G, suspender)
Extension from lower part of
internal oblique m.
Pass with spermatic cord to the
scrotum
Fxn.
In cold environment:
elevates testis superiorly
In warm environment:
relaxes & testis descend in the
scrotum
Covering Fasciae of Spermatic Cord
External Spermatic Fascia:
from external oblique m.
attached to superficial ring
Cremasteric Fascia:
the cremaster m.
from internal oblique m.
Internal Spermatic Fascia:
transversalis fascia
attached to deep ring
Abdominal Herniae
Abdominal Herniae
Hernia = L, rupture
Protrusion of abdominal organs to outside through abdominal
wall weakness
Diaphragmatic hernia:
usually in esophageal opening
-sliding or paraesophageal
Inguinal hernia: (in inguinal region)
Indirect (through inguinal canal)
Direct
Femoral hernia: through femoral canal
below inguinal lig.
Umbilical hernia
Indirect Inguinal Hernia
Part of the intestine passes through
the inguinal canal
- Most common form of abd. herniae
- 75% of inguinal hernias are indirect
- Most common in children & young
adults
Commonly enters the scrotum
20x  males than
females
Direct Inguinal Hernia
Usually medial to inf. epigastric a.
In Inguinal triagle area:
inf. epig. A.
rectus abdominis
inguinal lig.
Forms an inguinal sac by
transversalis fascia
Doesnot enter the scrotum
Intestine bulges directly ant.
Most common in old men
With weak abd. muscles
Clinical: Femoral Hernia
A protrusion of abdominal viscera (small intestine) into femoral canal
More common in female because: wider pelvis  wider femoral canal
Usually small (limited within the canal), however…
Umbilical Hernia
3 types
1. Congenital Umbilical Hernia
During fetal life
failure of midgut to return back
into abd. Cavity by ?? Week
2. Acquired Infantile Umbilical Hernia
Small hernia occurred in children
due to weakness in the scar of
umbilicus
appears only when the child cries,
cough or strain
3. Acquired Umbilical Hernia of Adults
(Paraumbilical hernia)
Does not protrude through
umbilical scar
Through linea alba in umbilical
region