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Inguinal Hernias Anatomy Inguinal ligament = ASIS to pubic tubercle Inguinal canal = ASIS to pubic symphysis o contents males: spermatic cord (vas deferens, testicular artery, testicular nerves, pampiniform plexus, lymphatic vessels), ilioinguinal nerve females: round ligament of the uterus, ilioinguinal nerve o borders of the inguinal canal MALT Muscle (internal oblique) - ROOF Aponeurosis (external oblique) - ANTERIOR Ligament (inguinal ligament) - FLOOR Tendon (transversalis fascia) - POSTERIOR ‘Points’ o mid-inguinal point = halfway between ASIS to pubic symphysis = femoral artery o midpoint of the inguinal ligament = midpoint between origins of inguinal ligament (ASIS to pubic tubercle) = deep (internal) inguinal ring Inguinal ring positions o deep (internal) inguinal ring = midpoint of inguinal ligament o superficial (external) inguinal ring = just superior and medial to pubic tubercle Direct VS Indirect Inguinal Hernia Direct inguinal hernia (40%) o herniated abdominal contents come directly out of abdomen in a straight line o penetrate through the external inguinal ring o if reduced, cannot be controlled by applying pressure over the deep inguinal ring Indirect inguinal hernia (60%) o herniated abdominal contents run in the inguinal canal o penetrate through the internal inguinal ring o can go right the way down the canal into the scrotum in men (inguinal-scrotal hernia) o due to failure of the closure of the processus vaginalis (4% of people) o if reduced, can be controlled by applying pressure over the deep inguinal ring Inguinal Hernia VS Femoral Hernia Classical differences o femoral hernia occurs below and lateral to pubic tubercle o direct inguinal hernia occurs above and medial to the pubic tubercle o indirect inguinal hernia can occur anywhere between the deep inguinal ring and the scrotum Differentials o psoas abscess (lateral to femoral artery) o femoral neurofibroma (hard swelling lateral to femoral artery; painful if pressed) © 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision Mid-inguinal point Femoral artery position Midpoint of inguinal ligament Deep (internal) inguinal ring position Superficial (external) inguinal ring position © 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision Image copyright free from the 20th U.S. edition of Gray's Anatomy of the Human Body, originally published in 1918 and therefore lapsed into the public domain