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Abdominal Wall (2):

Inguinal Region

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Surface Anatomy

9 regions classification

Subcostal plane:

lowest costal margin,

10 cc, L3

Transtubercular plane:

iliac tubercles

what vertebral level?

Midclavicular planes:

mid clavicle

mid inguinal lig.

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9 Regions

Rt. & Lf. Hypochondriac

Rt. & Lf. Lumbar

Rt. & Lf. Inguinal

Epigastric

Umbilical

Hypogastric (pubic)

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4 Regions classification

Transumbilical plane

IV disc L3-L4

Midsagittal line

symphesis menti

symphesis pubis

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Inguinal Region

The inf. part of anterolateralabdominal wall

Area of weakness:

Passage of spermatic cordthrough a canal (inguinal)

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Inguinal Canal

Superior & parallel to medial ofinguinal ligament

Runs oblique in inferomedial direction

Contents

1:

Male: spermatic cord

Female: round lig. of uterus

2: ilioinguinal n. (L1)

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Openings of Inguinal Canal

Deep inguinal ring (Internal):

entrance to the canal

above the middle of inguinal ligament

Oval opening in transversalis fascia

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Superficial inguinal ring:

Triangular exit

Due to defect in ???

Lateral & Medial (margins) Borders crura

Crura: attachment site for external fasciacovering the spermatic cord

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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)

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Conjoint Tendon

Merging of internal oblique aponeurosis & transversus abdominisaponeurosis to share a common insertion into pubic crest

Locatedposteromedial to

superficial ring

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Walls of Inguinal Canal

Roof:

arching fibers of Internal oblique m. & Transversus m.

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Walls of Inguinal Canal

Floor:

Inguinal Ligament

& Lacunar lig.

Lacunar Lig.:

medial continuation of inguinalligament

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

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Spermatic Cord

Contents

Ductus (vas) deferens

Testicular artery

a. to vas defernsCremasteric a.

Testicular Vein (pampiniform plexus)

Autonomic nerve fibersGenital branch of genitofemoral n.

(to cremaster muscle)

Lymphatic vessels

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Cremaster Muscle

Extension from lower part ofinternal oblique m.

Pass with spermatic cord to thescrotum

Fxn.

In cold environment:

elevates testis superiorly

In warm environment:

relaxes & testis descend in thescrotum

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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 fasciaattached to deep ring

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Inguinal Hernia

Hernia = L, rupture

Protrusion of abdominal organs to outside through abdominalwall weakness

Diaphragmatic hernia:usually in esophageal opening

-sliding or paraesophageal

Inguinal hernia: (in inguinal region)

Indirect (through inguinal canal)

Direct

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Indirect Hernia

75% of inguinal hernias are indirect

Part of the intestine pass through thecanal

Commonly enters the scrotum

20x males than

females

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Direct 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

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M - muscles

A aponeuroses

L - ligaments

T - transversalis/tendon