of the anterior abdominal wall, situated just above the medial half of the inguinal ligament Basic Anatomy Layer by layer dissection
➢ 4cm (1.5 inches) long
➢ Directed downwards, forwards and medially ➢ Extends from the deep to the superficial inguinal ring Basic Anatomy Deep Inguinal Ring Basic Anatomy Parts of the Inguinal canal
▪ Deep ring ▪ Superficial ring – Intercrural fibers ▪ Anterior wall ▪ Posterior wall ▪ Roof ▪ Floor Basic Anatomy
Layer by layer (schematic)
Basic Anatomy Contents of inguinal canal ▪ Round ligament or ▪ Spermatic cord – Vas deferens, gonadal vessels, sympathetic nerves, pampiniform plexus of veins, lymphatics ▪ Coverings of spermatic cord – Internal spermatic fascia, cremasteric muscle & fascia ▪ Processus vaginalis ▪ Genital branch of ▪ Ilioinguinal nerve Genitofemoral nerve Basic Anatomy Recap
Conjoint tendon Basic Anatomy Inguinal triangle of Hasselbach Basic Anatomy Clinical Anatomy ▪ Circle of Death (crown of death / corona mortis)
▪ Triangle of Doom ▪ Triangle of Pain
Quadrilateral of Disaster Basic Anatomy Hernia ➢ Abnormal protrusion of the contents of a cavity beyond the normal confines of the walls of that cavity ➢ Inguinal hernia – abnormal protrusion of abdominal viscera or part of a viscus or a mesentery through the Inguinal canal ➢ 2 types: ▪ Direct (medial/lateral) ▪ Indirect Basic Anatomy Inguinal Hernia ➢ Abnormal protrusion of the contents of a cavity beyond the normal confines of the walls of that cavity ➢ Inguinal hernia – abnormal protrusion of abdominal viscera or part of a viscus or a mesentery through the Inguinal canal ➢ 2 types: ● Indirect ● Direct (medial/lateral) Basic Anatomy Indirect & Direct Inguinal Hernia Basic Anatomy Direct inguinal hernias
• Medial to inferior epigastric artery
• Protrudes through posterior wall • Sac wall: transversalis fascia • Outside the processus vaginalis • Lies in inguinal (Hasselbach) triangle • Emerges through superficial ring • Gains a covering of external spermatic fascia Basic Anatomy
Indirect inguinal hernias
• Lateral to inferior epigastric vessels
• Enters the deep inguinal ring
• Traverses the inguinal canal
• Exits through superficial ring
• Enters the scrotum
Basic Anatomy Indirect & Direct Inguinal Hernia Feature DIRECT Inguinal Hernia INDIRECT Inguinal Hernia
Location Protrudes medial to inferior Protrudes lateral to inferior
epigastric artery through posterior epigastric vessels, traversing the wall of inguinal canal inguinal canal Neck Lies in medial inguinal fossa Lies in lateral inguinal fossa /(Hasselbach) triangle; broad at deep inguinal ring; narrow Sac Outside the processus vaginalis Formed by processus vaginalis
Coverings Includes Fascia transversalis; gains Same as spermatic cord
a covering of external spermatic throughout its course; exits fascia on emerging through the through superficial inguinal ring superficial inguinal ring and enters the scrotum Clinical Complications like obstruction, Obstruction and strangulation course strangulation & peritonitis unlikely likely if untreated; surgical repair mandatory Basic Anatomy
Indirect & Direct Inguinal Herniae Basic Anatomy Complications of Hernia • Reducible - Contents of sac maybe reduced spontaneously/pushed back manually - Expansile cough impulse
• Irreducible - Contents cannot be returned to peritoneal cavity because of: 1) Narrow neck of sac 2) Adhesions between sac & contents - May undergo the following complications: 1) Incarceration – adhesions between sac & contents 2) Obstruction – compressed hollow viscus (usually small bowel) trapped in the sac due to narrow neck 3) Strangulation – compressed vessels & blood supply of contents compromised; gangrene & peritonitis imminent unless surgically reduced Basic Anatomy Basic Anatomy Basic Anatomy Basic Anatomy
