Inguinal Canal and Hernias

Question 1

What are the boundaries of the Hasselbach Triangle?

Answer 1

Medial: Lateral wall of RA

Superior: Inferior epigastric vessels

Inferior: Inguinal Ligament

Question 2

How long is the Inguinal Canal?

Answer 2

4cm

Question 3

What guides the descent of testes

Answer 3

Gubernaculum

Question 4

What are the layers of the Inguinal Canal?

Answer 4

Transversalis fascia
Int. Oblique musculature
Ext. Oblique aponeurosis

Covering from the transversus abdominis muscle is not acquired because the processus vaginalis passes under the arching fibres of this abdominal wall muscle

Question 5

What are the relations of the Deep Inguinal Ring?

Answer 5

Superior to middle of Inguinal Ligament

Lateral to Inferior Epigastric Vessels

At arched lower margin of Transversus Abdominis

Question 6

What muscle closes the deep inguinal ring when contracted?

Answer 6

Internal Oblique

Question 7

What are the relations of the Superficial Inguinal Ring?

Answer 7

Supero-lateral to pubic tubercle

Question 8

What do the crura of the Superficial Inguinal Ring attach to?

Answer 8

Lat. crux attaches to Pubic Tubercle

Med. crux attaches to Pubic Crest

Question 9

What are the boundaries of the Inguinal Canal at the Deep Ring (Lateral third)

Answer 9

Roof:
Transversalis fascia

Ant. Wall:

• Internal oblique
• Crus of ext. oblique aponeurosis

Floor:
Iliopubic Tract (thickened part of Transversalis Fascia)

Post. wall:
Transversalis Fascia

TIIT

Question 10

What are the boundaries of the Inguinal Canal in the middle

Answer 10

Roof:
Musculo-aponeurotic arches of int. oblique and transversus abdominis

Ant wall:
Lateral crus and intercrural fibres

Floor:
Inguinal ligament

Post. wall:
Transversalis fascia

Make Love in Tents

Question 11

What are the boundaries of the Inguinal Canal at the Superficial Ring (medial third)

Answer 11

Roof:
Medial Crus

Ant wall:

• Intercrural fibres
• External spermatic fascia

Floor:
Lacunar Ligament

Post. wall:

• Inguinal falx (conjoint tendon)
• Reflected inguinal ligament

Question 12

What are the contents of the Inguinal Canal

Answer 12

Ilioinguinal nerve

Women:
Round ligament of uterus
Genital branch of genitofemoral nerve

Men:
Spermatic cord

Question 13

What are the contents of the spermatic cord

Answer 13

vas deferens
testicular arteries
artery to vas
vremasteric artery
cremaster muscle
pampaniform plexus of veins
lymphatics
genital branch of genitofemoral nerve
extraperitoneal fat

Question 14

What is the predisposing factor of an indirect vs. direct inguinal hernia?

Answer 14

Indirect:
Persistant Processus Vaginalis (or Canal of Nuck in females)

Direct:
Weakened Hesselbach’s Triangle

Question 15

What are the courses of an indirect vs direct inguinal hernia

Answer 15

Indirect:
Herniating sac protrudes through entire length of inguinal canal

Direct:
Herniating sac directly protrudes into inguinal canal without passing through deep ring

Question 16

What are the differences in coverings of the herniating sac of a direct vs indirect inguinal hernia

Answer 16

Indirect:

• Peritoneum of Processus vaginalis
• Three fascical coverings of spermatic cord (or round ligament)

Direct:
Peritoneum
Transversus fascia

Question 17

What are the relations of an indirect vs direct inguinal hernia to the spermatic cord

Answer 17

Indirect:
In spermatic cord

Direct:
Lateral and posterior to spermatic cord

Question 18

What are the relations of an indirect vs direct inguinal hernia to the Inferior Epigastric Vessels

Answer 18

Indirect: Lateral
Direct: Medial

Question 19

Which is more common, direct or indirect inguinal hernias

Answer 19

Indirect (2/3 of all)