ANATOMY OF INGUINAL CANAL

Inguinalcanal is an oblique passage in the lower part of anterior abdominal wall and itconveys spermatic cord in males and round ligament of uterus in males.

Situation
Just abovethe medial half of inguinal ligament in both sides.

Lengthand Direction
Approximately4cm(1.5 inches). Directeddownwards forwards and medially.

Extent
From deepinguinal ring to superficial inguinal ring. Deep inguinal ring: oval opening in fascia transversalis situated 1.2cm abovethe midinguinal point,and

immediately lateral to the stem of inferior epigastric artery. Superficial inguinal ring: Triangular gap in external obliqueaponeurosis.Base of the triangle is formed by pubic crest and two sides by lowerand upper margins of the opening

Boundaries
it hasanterior wall,posterior wall,roof and floor. ROOF
Arched fibres of internal oblique andtransversus abdominis muscles

ANTERIOR WALL
whole extent: fascia,external oblique skin,superficial aponeurosis

POSTERIOR WALL Inguinal canal

whole extent:fascia transversalis,extra peritonealtissue,parietal peritoneum medial two-thirds:conjoint tendon,reflected part of inguinal ligament Lateral onethird:interfoveolar ligament.

lateral one-third:internal oblique muscle

FLOOR
Grooved upper surface of inguinalligament

Diagramshowing boundaries of inguinal canal:

SexDifference
Larger andmore prominent in males than in females

Contents
In males:Spermatic cord In females:Round ligament of uterus In bothsexes: Ilioinguinal nerve

Constituentsof Spermatic Cord

1. Ductusdeferens 2.Testicular artery,cremasteric artery,artery of ductus deferens 3.Pampiniform plexus of veins 4. Lymphvessals from testis 5. Genitalbranch of genitofemoral nerve 6. Remainsof processus vaginalis

Coveringsof Spermatic Cord

From withinoutwards 1. 2. 3.

a) Internal spermatic fascia b)

Cremasteric fascia

c) External spermatic fascia

Mechanism of Inguinal Canal

1. Obliquity of inguinal canal: When the intra-abdominal perssurerises,the anterior and posterior walls of canal are approximated 2. Superficial inguinal ringis guarded from behindby conjoint tendon and reflected part of inguinal ligament 3. Deep inguinal ring isguarded from the frontby fleshy fibres of internal oblique 4. Shutter mechanism of internaloblique: This muscle hastriple relation to inguinal canal.so when it contracts,the roof is approximatedto floor,like a shutter 5. Contraction of cremaster helps thespermatic cord to plug the superficial inguinal ring 6. Contraction of external obliqueresults in approximation of two crura of superficial inguinal ring

ClinicalApplications
Inguinal Hernia :

It is theprotrusion of abdominal cavity contents through the inguinal wall or inguinalcanal. Classification:

1. Indirect or Oblique inguinal hernia: Protrusion occurs through deep inguinalring,inguinal canal,superficial inguinal ring into scrotum. Occurs due to partial or complete patency of processus vaginalis. It maydescend into scrotum

Coverings: a) Extra peritoneal tissue b) Internal spermatic fascia c) Cremasteric fascia

d) External spermatic fascia e) Skin Subtypes: a) Vaginal or complete b) Congenital funicular c) bubonocele

2. Direct inguinal hernia: Protrusion occurs through weak posterior wall of inguinalcanal through Hesselbachs triangle,inferior epigastric artery, lateral borderof rectus abdominis, and inguinal ligament. Coverings of lateraldirect inguinal hernia: a) Extraperitoneal tissue b) Fascia transversalis c) Cremasteric fascia

d) External spermatic fascia e) Skin Coveringsof medial direct inguinal hernia:

a) Extraperitoneal tissue b) Fascia transversalis c) Conjoint tendon

d) External spermatic fascia e) Skin Direct inginal hernia

Weakness posterior wall inguinalcanal Chronic bronchitis, 2. 3. Precipitatingfactors On standing Enlarged prostate Comes out Does not comes out of of Preformed sac

Indirect inguinal hernia

1.

Aetiology

4.

Direction ofsac

It comes ofHesselbachs triangle

out Sac comes through the deep inguinalring

5.

obstruction

Not common because Common, as neck is of wide neck narrow Not seen

6.

internal ringocclusion The swelling is seen test Relationship Medial toinferior epigastric vessels Covered byinternal No spermatic fascia?

7.

Lateral

8.

Yes

9.

Usual onset

Adult

Congenital