Inguinal Region

Peer Support10/08/2012

Rachel Edgar & Amrit Sandhu

What we are going to cover!

Inguinal canalHerniasBorders of a direct herniaDifferentiating between a direct and indirect herniaDifferentials for a lump in the groin

Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

The Inguinal Canal

What is it?Oblique passage through lower part of abdominal cavityRuns between deep and superficial Inguinal rings

What goes through it? Transmits spermatic cord in malesTransmits round ligament of uterus in females

M

A

L

TAnterior

Posterior

Roof

Floor

M

A

L

TAnterior

Posterior

Roof

Floor

Arching MUSCLE fibres of the Internal Oblique and Transversus Abdominus

APONEUROSIS of the External Oblique and Internal Oblique

Inguinal LIGAMENTLacunar LIGAMENT

TRANSVERSALIS fascia & Conjoint TENDON

Parietal Peritoneum

Transversalis fascia

Ductus deferens

Processus vaginalis

Tunica vaginalis(part covering testicle)

The testicle is retroperitoneal and descends through the anterior abdominal wallIt pulls a fold of peritoneum with it that forms the tunica vaginalis

This region is the developing inguinal canal

Midpoint of the inguinal ligament The inguinal ligament runs from the pubic tubercle to the anterior superior iliac spine, so the midpoint is halfway between these structures. The opening to the inguinal canal (deep inguinal ring) is located just above this point.

Mid-inguinal point Halfway between the pubic symphysis and the anterior superior iliac spine. The femoral artery crosses into the lower limb at this anatomical landmark.

Deep Inguinal RingLies between the midpoint of inguinal ligament & the midinguinal point (1cm above the inguinal ligament)

Superficial RingLies supero-lateral to the pubic tubercle. Point of emergence of spermatic cord (male) or round ligament and coverings (female)

Hernias

Define herniaThe protrusion of a structure from its normal cavity through an abnormal opening

How can they be described?Reducible Contents easily put backIncarcerated: Cannot be reducedStrangulated Contents are stuck, and there is constriction of the tissues at the neck of the hernia, leading to reduced venous drainage and arterial occlusion

DirectMedial to inferior epigastric vessel

Direct goes directly through Hesslebach’s Triangle

Lateral to inferior epigastric artery

Passes through processus vaginalis via deep & superficial inguinal rings

Travels into scrotum

Congenital type

Common in males

Indirect

Dr, Dr there is a lump in my groin, what on earth could it be?!

DDx

Hernias Very Much Like To SwellHernias (inguinal & femoral)Vascular (femoral aneurysm, sapheno varyx)Muscle (psoas abscess)Lymph nodesTesticle (ectopic, undescended)Spermatic cord (lipoma, hydrocele)

Quick Fire QuizHow can you differentiate a hydrocele? Trans illuminate

Where is fluid collecting in a hydrocele?Between the visceral and parietal tunica vaginalis

A lump lateral and below the pubic tubercle is likely to be what kind of hernia?Femoral herniaAn inguinal hernia is above/above and medial to the pubic tubercle

Who are femoral hernias more common in?Females

Who are indirect hernias more common in?Males

An indirect hernia is due to the failure of what?Failure of complete obliteration of the process vaginalis

Thank you!

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If you have any questions about this topic feel free to ask us, you’re not in it alone!

Some sites you might find useful

• http://teachmeanatomy.info/abdomen/the-inguinal-canal/

• http://www.instantanatomy.net/inguinal.pdf