Inguinal region
Inguinal region
Maria Rodríguez, ilenbravodiaz@gmail.com
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Introduction
• Inguinal region
• Inguinal canal
• Boundaries
• Openings
• Contents
• Hernias
• Indirect
• Direct
The inguinal region is vitally important!
It is a complex area of anatomy with numerous
structures entering and leaving the abdomen;
clinically, it is important as it is a major site
of herniation.
Maria Rodríguez, ilenbravodiaz@gmail.com
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Surface anatomy inguinal region
The inguinal region is an area of the abdominal wall that extends from the ASIS to the pubic
tubercle. The inguinal canal is found here, which contains the spermatic cord in the male and
the round ligament of the uterus in the female.
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal canal
Anterior Posterior
1 2 3
1 External oblique
2 oblique
3 Transversus abdominis
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal canal
Remember the layers of the anterolateral
abdominal wall?
They still exist in the inguinal region, but
are arranged to form the inguinal canal.
The inguinal canal has four boundaries:
• Anterior wall
• Posterior wall
• Roof
• Floor
Also has an opening at each end:
• Superficial inguinal ring
• Deep inguinal ring
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal canal
Observe:
• The free edge of the external oblique
aponeurosis forms the inguinal ligament
• The contents of the spermatic cord passing
from deep layers (within the abdomen) to
superficial layers (within the scrotum/labia)
• SC passing through transversalis fascia
lateral to inferior epigastric vessels
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal canal
Observe:
• SC also passing through internal oblique
• Transversus abdominis and internal oblique
passing over SC
• Transversus abdominis and internal oblique
converge behind superficial inguinal ring =
conjoint tendon
Maria Rodríguez, ilenbravodiaz@gmail.com
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Boundaries of inguinal canal
Boundary Level of deep ring Middle Level of superficial
ring
Anterior wall Internal oblique
External oblique
External oblique
aponeurosis
External oblique
aponeurosis (crura)
Posterior wall Transversalis fascia Transversalis fascia Conjoint tendon
Roof Transversalis fascia Arching fibres of
internal oblique and
transversus abdominis
Medial crus of external
oblique
Floor Inguinal ligament Inguinal ligament Lacunar ligament
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal canal - contents
Male spermatic cord
• Ductus deferens
• Artery of ductus deferens
• Testicular artery
• Cremasteric artery
• Pampiniform venous plexus
• Sympathetic nerve fibres
• Genital branch of genitofemoral nerve
• Lymphatic vessels
Female
• Round ligament of the uterus
Due to the significant size of the spermatic
cord compared to the round ligament of the
uterus, the superficial inguinal ring is much
bigger = increased possibility of hernias in
males.
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal canal - contents
Male spermatic cord
• Ductus deferens
• Artery of ductus deferens
• Testicular artery
• Cremasteric artery
• Pampiniform venous plexus
• Sympathetic nerve fibres
• Genital branch of genitofemoral nerve
• Lymphatic vessels
Female
• Round ligament of the uterus
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
© www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt.
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Spermatic cord - coverings
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
Maria Rodríguez, ilenbravodiaz@gmail.com
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Spermatic cord - coverings
Three layers cover the spermatic cord
All of them are derived from structures
in the abdominal wall
1. External spermatic fascia
= External oblique
2. Cremasteric fascia/muscle
= Internal oblique
3. Internal spermatic fascia
= Transversalis fascia
These coverings result from the testes
descending from the posterior abdominal
wall to the scrotum during embryological
development.
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Hernia = the protrusion of an organ through
the wall of the compartment that contains it
Think about the causes:
1. Changes in intra-abdominal pressure
• Lifting
• Chronic cough/sneezing
2. Contents of abdomen
• Intestines
3. Potential sites of weakness
• Inguinal rings
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Hernia = the protrusion of an organ through
the wall of the compartment that contains it
Think about:
• Inguinal hernia = protrusion of the
intestines through the abdominal wall in
the inguinal region
• 2 potential sites of weakness =
superficial and deep inguinal rings
• 2 different types = direct and indirect
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Indirect Direct
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Direct
Indirect
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Indirect Direct
Direct (acquired)
• Protrusion occurs at level of superficial ring
• Leaves abdomen medial to inferior epigastric
vessels
• Hernial sac limited by peritoneum and
transversalis fascia
• Does not usually enter scrotum
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Direct (acquired)
• Protrusion occurs at level of superficial ring
• Leaves abdomen medial to inferior epigastric
vessels
• Hernial sac limited by peritoneum and
transversalis fascia
• Does not usually enter scrotum
Indirect Direct
Maria Rodríguez, ilenbravodiaz@gmail.com
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Inguinal hernias
Indirect (congenital)
• Protrusion occurs at level of deep ring (patent
processus vaginalis; typically in young males)
• Leaves abdomen lateral to inferior epigastric
vessels; traverses canal and can enter the
scrotum via superficial ring
• Hernial sac in persistent processes vaginalis
• More common than direct hernias
Indirect Direct
Maria Rodríguez, ilenbravodiaz@gmail.com
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Conclusion
• Inguinal region
• Surface landmarks
• Inguinal canal
• Muscles and ligaments that form the boundaries of the canal
• An opening at either end: superficial and deep inguinal ring
• Contents: spermatic cord in male, round ligament of uterus in female
• Hernias
• Indirect: congenital, lateral to inferior epigastric vessels, enters scrotum
• Direct: acquired, medial to inferior epigastric vessels, rarely enters scrotum
Maria Rodríguez, ilenbravodiaz@gmail.com
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Dieses Dokument gehört: Maria Rodríguez
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Maria Rodríguez, ilenbravodiaz@gmail.com
© www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt.
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