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Abdominal Wall (2):Abdominal Wall (2):Inguinal RegionInguinal Region

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Inguinal RegionInguinal Region

The inf. part of anterolateralabdominal wall

Area of weakness:

Passage of spermatic cordthrough a canal (inguinal)

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Inguinal CanalInguinal Canal

Superior & parallel to medial of inguinal ligament

Runs oblique in inferomedial direction

Contents1:

Male: spermatic cord

Female: round lig. of uterus

2: ilioinguinal n. (L1)

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O penings of Inguinal CanalO penings of Inguinal Canal

Deep inguinal ring (Internal):

entrance to the canal

above the middle of inguinal ligament

O val 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 canalWalls of the canal

Anterior:External oblique aponeurosis

reinforced on lat. 1/3 by:Internal oblique aponeuroses.

Posterior:Transversalis fascia

Reinforced medially by:Insertion of int. oblique &transversus m. ( Conjoint tendon )

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Conjoint TendonConjoint 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 CanalWalls of Inguinal CanalRoof (superior wall):

arching fibers of Internal oblique m. & Transversus m.

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Walls of Inguinal CanalWalls of Inguinal Canal

Floor (inferior wall):Inguinal Ligament& Lacunar lig.

Lacunar Lig.:medial continuation of inguinal

ligament

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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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M - muscles

A aponeuroses

L - ligaments

T - transversalis/Tendon

Sup

Ant Post

Inf

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Spermatic CordSpermatic Cord

Contents

Ductus (vas) deferens

Testicular arterya. to vas deferensCremasteric a.

Testicular Vein (pampiniform plexus)

Autonomic nerve fibersGenital branch of genitofemoral n.(to cremaster muscle)

Lymphatic vessels

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Cremaster MuscleCremaster Muscle

Extension from lower part of internal oblique m.

Pass with spermatic cord to thescrotum

Fxn.In cold environment:

elevates testis superiorly

In warm environment:relaxes & testis descend in the

scrotum

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Inguinal HerniaInguinal Hernia

Hernia = L, ruptureProtrusion 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

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Indirect HerniaIndirect Hernia

75% of inguinal hernias are indirect

Part of the intestine pass through thecanal

Commonly enters the scrotum

20x males thanfemales

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Direct HerniaDirect Hernia

Usually medial to inf. epigastric a.

In Inguinal triangle area:

inf. epig. A.rectus abdominisinguinal lig.

Forms an inguinal sac by

transversalis fascia

Does not enter the scrotum

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Surface AnatomySurface Anatomy

9 regions classification

Subcostal plane:lowest costal margin,10 cc, L3

Transtubercular plane:iliac tuberclesw hat 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-L 4

Midsagittal line

symphesis menti

symphesis pubis