Inguinal canal

Question 1

Borders of the inguinal canal

Answer 1

Anterior = aponeurosis of external abdominal oblique muscle. Reinforced laterally by the internal oblique muscle.

Posterior = transversalis fascia

Superior = falx inguinalis (conjoint tendon)

Inferior = inguinal ligament

Medial = reflected ligament

Question 2

Contents of the inguinal canal

Answer 2

• Inferior epigastric artery
• Genital branch of the genitofemoral nerve
• Spermatic cord in men
• Round ligament of the uterus in women
• Ilioingulnal nerve passes through the superficial inguinal ring, but not the deep.

Question 3

Fascias of the inguinal canal

Answer 3

3 fascial layers:

External spermatic fascia (from external abdominal obliquie)

Cremasteric fascia (from internal abdominal oblique)

Internal spermatic fascia (from transversalis fascia)

Question 4

Explain the deep inguinal ring

Answer 4

• Lateral to the inferior epigastric vessels.
• Beggining of the tubular envagination of transversalis fascia that forms the internal spermatic fascia of the spermatic cord in med and the roung ligament of the uterus in women.

Question 5

Explain the superficial ingunal ring

Answer 5

• Triangluar opening in the aponeuroses of the external oblique (NOT the Hesselbach’s triangle)
  
  • Apex pointing superolaterally
  • Base formed by the pubic crest
  • Sides formed by medial and lateral crus
    
    • Medial and lateral crus held together by intercrural fibres at the apex of the triangle
• Beginning of the tubular evagenation of the aponeurosis of the external obliquie onto the structures traversing the inguinal canal and emerging from the superficial inguinal ring.
  
  • External spermatic fascia.

Question 6

Explain inguinal hernias.

Answer 6

Indirect hernia:

Through the deep inguinal ring.

Most common.

Occurs laterally to the inferior epigastric vessels.

Direct hernia:

• Through the posterior wall of the inguinal canal.
• Occurs medially to the inferior epigastric vessels.
• Comes through the Hesselbach’s/inguinal triangle. Borders:
  
  • Laterally by theinferior epigastric artery
  • Medially by the rectus abdominis muscles
  • Inferiorly by the inguinal ligament