Download Inguinal

Inguinal canal
Objectives
• Location and extent
• Boundaries and relations
• Functional significance
• Chronological progress of the descent of testes
• Processes vaginalis
• Contents of the inguinal canal in male and female
• Inguinal mechanisms
• Inguinal hernia.
• Differential diagnosis of Inguinal hernia
18th September 2003,
Dr.Suj.
Inguinal canal
Inguinal canal
contd
contd
Boundaries
Location and extent,
•
Floor ;
the grooved upper surface of the inguinal ligament
the medial half of the inguinal ligament extending from the deep inguinal ring
•
Roof ;
the arching lower fibers of Internal oblique abdominis
to the superficial inguinal ring.
•
Anterior wall ;
the External oblique aponeurosis all through its extent
An oblique inter-muscular slit located in the anterior abdominal wall, abov e
The deep inguinal ring :
an opening in the transversalis fascia, about a thumbs breadth [1.25cm]
above the mid inguinal point .
The superficial inguinal ring :
an opening in the External oblique aponeurosis
reinforced laterally by the Internal oblique muscle
•
Posterior wall ;
the Transversalis fascia all through its extent,
reinforced Medially by the conjoint tendon =
( Fused fibers of transversus abdominis and internal oblique muscles ).
supero medial to the pubic tubercle.
Inguinal canal contd.
Contents
In the males
– Spermatic cord : its contents and coverings,
– Ilioinguinal nerve,
– Cremaster and its blood supply,
– Genital branch of genitofemoral nerve,
– Remnants of processes vaginals
Contents and coverings of the spermatic cord• Vas deferens & its artery,
• Testicular artery and pampiniform plexes of veins,
• Llymphatics
Covered by spermatic fasciae.
In the female
– Round ligament of uterus,( remnant of Gubernaculum )
– Genital branch of genitofemoral nerve,
– Ilioinguinal nerve.
– Cremaster and its blood supply,
– Remnants of processes vaginalis.
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Inguinal canal contd.
Inguinal canal contd.
Land marks in the inguinal region;
•
Inguinal mechanisms
• Anterior superior iliac spine
– Obliquity of the inguinal canal,
• Pubic tubercle
– Strength of lateral aspect of its anterior wall,
– Strength of medial aspect of its posterior wall,
• Femoral pulse in relation to mid inguinal point
• Deep inguinal ring in relation to midpoint of the inguinal ligament
– Arching internal oblique muscle fibers of its roof: shutter mechanism,
– Sphincteric effect of the Interfoviolar fibers of Transversus abdominis
• Inferior epigastric artery at surgery for inguinal hernia
at the deep inguinal ring,
• Aberrant obturator artery in relation to femoral ring
– Obliteration of the processus vaginals.
• Superficial inguinal ring in relation to pubic crest and pubic tubercle.
Inguinal canal contd.
Gubernaculum
Descent
Descent of
of testes
testes
In
In the
the embryonic
embryonic stage
stage the
the testes
testes are
are located
located in
in the
the
abdomen
abdomen
During
During the
the foetal
foetal peirod
peirod the
the testes
testes travel
travel retro
retro peritoneally
peritoneally
from
from the
the abdomen
abdomen into
into the
the Inguinal
Inguinal canal,
canal,
At
At birth
birth testes
testes are
are just
just proximal
proximal or
or distal
distal to
to the
the
superficial
superficial inguinal
inguinal ring,
ring,
Inguinal canal
contd.
Fibro muscular structure
extending from the gonad
to the labio scrotal swellings
during embryogenesis,
In the male, at the end of the
descent of testis, it becomes
a thin fibrous ligament =
Scrotal ligament.
Eventually
Eventually the
the testes
testes reach
reach the
the fundus
fundus of
of the
the scrotum.
scrotum.
In the female, it becomes
ligament of ovary and
the round ligament of uterus.
Anatomical
Anatomical structures
structures that
that aid
aid the
the descent
descent of
of testes:
testes:
Gubernaculum:
Gubernaculum: and
and
Processus
Processus vaginals:
vaginals:
Inguinal canal contd.
Processes vaginalis
Inguinal canal contd.
Processes vaginalis is a pre set prolongation of parietal peritonium into the
inguinal canal to provide a smooth passage for the descent of gonad
gonad into the
scrotum.
Usually gets obliterated after the descent of the, gonad and becomes
becomes an
insignificant fibrous structure,
In males
In some males it remain patent and may allow herniation of abdominal
contents through the inguinal canal into the scrotum.
In females
In some females it remain patent and may allow herniation of abdominal
contents through the inguinal canal into the labium majus
majus..
Abnormalities of the descent of testes
– Retractile testes
– Un descended testes,
– Cryptorchidism,
– Ectopic testes,
– Superficial Inguinal pouch
– Penile
– Perineal
Regular peritoneal reflection
Processus vaginalis
Symphicis pubis
– Femoral
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Inguinal hernia
Types of herniae in relation to inguinal canal.
What is a hernia ?
Protrusion of contents of a cavity through an area of weakne ss of its wall
• Indirect
• Direct
Inguinal canal is one of the weak areas of the anterior abdominal wall,
Deep inguinal ring
O
O
O
O
O
O
O
o
Deep inguinal ring
protrusion of contents of the abdomen through the inguinal c anal is called
inguinal hernia.
Conjoined tendon
Indirect
Surerficial inguinal ring
Direct
Inguinal canal contd
Inguinal hernia condt.
Indirect Inguinal hernia ;
Passes through the deep inguinal ring into the
Inguinal canal,
•
lateral to the inferior epigastric artery
•
preceding structure is parietal peritoneum.
Direct Inguinal hernia;
Protruds in relation to
the posterior wall of the inguinal canal
at the Hesselbach’s triangle,
•
medial tothe inferior epigastric artery
•
preceding structure is transversalis fascia.
Differential diagnosis of Inguinal hernia
Enlarged Inguinal lymph node
Cyst of the spermatic cord
Ectopic Testis
Undescended testis
Lipoma of the spermatic card
Femoral hernia
Infantile Hydrocele
Varicocityof pampiniform plexes
In females
Cyst of the canal of Nuck,
Bartholen’s cyst
etc.
Always explain about incarceration of hernia to
the patient./ parent
End of topic
Thank the Lord
for reminding you
to examine the scrotum
as part of examination of the abdomen.
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