1. Abdominal Wall (2): Inguinal Region

2. Inguinal Region The inf. part of anterolateral abdominal wall
Area of weakness:
Passage of spermatic cord through a canal (inguinal)

3. 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)

4. Openings of Inguinal Canal
Deep inguinal ring (Internal):
entrance to the canal
above the middle of inguinal ligament
Oval opening in transversalis fascia

6. Superficial inguinal ring:
Triangular exit
Due to defect in ???
Lateral & Medial (margins) Borders  crura
Crura: attachment site for external fascia covering the spermatic cord

8. 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)

9. Conjoint Tendon
Merging of internal oblique aponeurosis & transversus abdominis aponeurosis to share a common insertion into pubic crest
Located posteromedial to superficial ring

10. Walls of Inguinal Canal
Roof:
arching fibers of Internal oblique m. & Transversus m.

11. Walls of Inguinal Canal
Floor:
Inguinal Ligament
& Lacunar lig.
Lacunar Lig.:
medial continuation of inguinal ligament

12. Lacunar Lig.: a small part of inguinal ligament fibers that reflected from pubic tubercle & attach to the pubic ramus

13. Lacunar Ligament

14. M - muscles
A - aponeuroses
L - ligaments
T - transversalis/tendon
Conjoint Tendon?
Lacunar Lig.?

15. Spermatic Cord

16. 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

17. 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

18. 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

19. Abdominal Herniae

20. 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

21. 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

22. 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

24. 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…

25. 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

27. 3. Acquired Umbilical Hernia of Adults (Paraumbilical hernia) Does not protrude through umbilical scar Through linea alba in umbilical region