1. INGUINAL CANAL

2. OBJECTIVES Definition Extent Boundaries
Structures passing through the canal
Protecting mechanism
Applied aspects

3. DEFINITION
Oblique passage in the lower part of the anterior abdominal wall,situated just above the inguinal ligament.

4. EXTENSION – Deep inguinal ring to Superficial inguinal ring
LENGTH – About 4cm
EXTENSION – Deep inguinal ring to Superficial inguinal ring
Deep inguinal ring
Superficial inguinal ring

5. PECULIARITIES In females canal is narrow
In newborns the canal is directed almost straight

6. ANTERIOR ABDOMINAL WALL

7. SUPERFICIAL INGUINAL RING.
Hiatus in the external oblique aponeurosis.
Triangular in shape.
Base is the crest of the pubis.
Sides are the margins of the opening in the aponeurosis(crura).
The lateral crus is stronger

8. The medial crus is thin,flat band attached to the front of the pubis and interlacing with the opposite crus.
Intercrural fibres -Some of the fibres of investing fascia of external obliqe,arch above the apex of superficial inguinal ring as intercrural fibres.

9. DEEP INGUINAL RING. Situated in transversalis fascia,
about 1.25cm above the mid inguinal point,lateral to the stem of inferior epigastric artery.

11. BOUNDARIES OF INGUINAL CANAL.
ANTERIOR WALL
IN ITS WHOLE EXTENT
Skin
Superficial fascia
External oblique aponeurosis
IN LATERRAL ONE-THIRD
Fibres of internal oblique

12. BOUNDARIES OF INGUINAL CANAL
POSTERIOR WALL
ENTIRELY FORMED BY
Fascia transversalis
MEDIAL-HALF
Conjoint tendon
MEDIAL ONE -FOURTH
Reflected part of inguinal ligament

13. Transversus abdominis
roof
Arched fibers of the internal oblique and transversus abdominis muscle.
Floor
Grooved upper surface of the inguinal ligament,
Medial end: upper surface of the lacunar ligament.
Internal oblique
Grooved surface

14. CONTENTS
1)Spermatic cord in males; round ligament of the uterus in females. 2)Ilio-inguinal nerve in both sexes

15. INGUINAL TRIANGLE OF HESSELBACH.
Peritoneal triangle in the posterior wall of the inguinal canal.
BOUNDARIES
Lateral – Inferior epigastric artery.
Medial – Lateral border of rectus abdominis.
Inferior – Inguinal ligament.

16. DEFENSIVE MECHANISM OF INGUINAL CANAL
1) Obliquity of the canal Deep and superficial rings are at different planes 2) Guarding-mechanism Opposite to the deep ring : anterior wall is strengthened by fleshy fibers of the internal oblique muscle. Opposite to the superficial ring: posterior wall by conjoint tendon and reflected part of inguinal ligament. 3) Slit-valve mechanism Due to approximation of the two crura of the superficial inguinal ring.

17. 4) Flap-valve
The posterior wall of the canal is pushed forwards and comes in contact with the anterior wall , obliterating the canal like a flap valve.

18. 5) Shutter mechanism
Arched fibers of internal oblique and transversus act as demi-sphincters. In increased intra abdominal pressure, it obliterate the canal by bringing the roof in contact with the floor.

19. 6) Ball-valve action
In increased intra-abdominal pressure, cremaster muscle contracts and pulls the testis towards the superficial ring.

20. HERNIA

21. What is a hernia??
An abnormal protrusion of a viscus or a part of a viscus through a weak point (opening) in the walls of its containing cavity.

22. Increase in intra abdominal pressure due to:
ETIOLOGY OF HERNIA
Increase in intra abdominal pressure due to:
Persistent cough
Straining
Smoking

23. INGUINAL HERNIA
INDIRECT
DIRECT

24. INDIRECT
DIRECT

25. INDIRECT INGUINAL
A) Bubunocele
B) Funicular
C) Complete

26. TREATMENT Herniotomy Herniorraphy Hernioplasty Open method
Laparoscopic method