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