16. Inguinal Region and Hernias

Question 1

What is another name for the inguinal region?

Answer 1

Groin

Question 2

What is the inguinal region?

Answer 2

• The inguinal region extends between the anterior superior iliac spine and the pubic tubercle, bounded inferiorly by the inguinal ligament, which runs between the ASIS and the pubic tubercle.
• Clinically, this is an important anatomical site as this is a site where structures enter and leave the abdomen and a common region of hernia formation.

Question 3

What is the inguinal ligament, where does it attach and what forms it?

Answer 3

• It is the aponeurosis of the external oblique muscles
• It attaches at the anterior superior iliac spine and pubic tubercle
• It forms part of the boundaries of the inguinal canal

Question 4

What is the inguinal canal?

Answer 4

The inguinal canal is a fibrous canal within the inguinal region through which structures pass from the abdominal wall to the external genitalia.

Question 5

What forms each side of the inguinal canal?

Answer 5

• Roof -> Arching fibres of internal oblique & transversus abdominis
• Anterior wall -> External oblique aponeurosis
• Posterior wall -> Transversalis fascia; medially, the conjoint tendon
• Floor -> Infolding of inguinal ligament

Question 6

What is the contents of the inguinal canal in males and females?

Answer 6

• Males:
  
  • Spermatic cord
  • Ilioinguinal nerve
• Females:
  
  • Round ligament of the uterus
  • Ilioinguinal nerve

Question 7

What important structure does the descent of the testis give rise to?

Answer 7

Inguinal canal

Question 8

What is found at either end of the inguinal canal?

Answer 8

• Deep inguinal ring -> On the proximal side
• Superficial inguinal ring -> On the distal side

Question 9

Show how the inguinal canal can be found using surface anatomy.

Answer 9

The deep inguinal ring is found approximately 1.5cm superior to the midpoint of the inguinal ligament.

Question 10

What is the conjoint tendon and what forms it?

Answer 10

• It is the lower part of the common aponeurosis of the internal oblique muscle and the transversus abdominis
• It forms part of the boundaries of the inguinal canal

Question 11

The mid-inguinal point is the landmark of…

Answer 11

Femoral artery

Question 12

Compare an indirect and direct inguinal hernia.

Answer 12

Indirect:

• Congenital
• Contents pass through deep inguinal ring, inguinal canal and then the superficial inguinal ring

Direct:

• Not congenital
• Contents buldge out through a weakness in Hesselbach’s triangle and pass through the superficial inguinal ring -> Do not pass through deep inguinal ring or inguinal canal

Question 13

What are the contents of the femoral sheath?

Answer 13

Femoral vein, artery, nerve and lymphatics of the superior part of the lower limb.

Question 14

What are femoral hernias?

Answer 14

Femoral hernias are protrusions of small bowel into the femoral canal, the medial-most compartment of the femoral sheath.

Question 15

How can femoral and inguinal hernias be distinguished?

Answer 15

Femoral hernias can be distinguished from inguinal hernias by their location: they are found inferior to the inguinal ligament, although this is often difficult to determine in clinical practice

Question 16

What is the lacunar ligament?

Answer 16