Inguinal Region Flashcards
Origin and Insertion of Rectus Abdominis muscle
O: 5th / 6th / 7th costal cartilages (Xp)
I: Pubic crest (/ PT/PS)
- Linea Alba CT band separating paired muscles
Origin and Insertion and Action of
1: External Oblique
O: ribs 5-12
I: linea alba, pubic crest, PT, anterior 1/2 iliac crest
A: contralateral rotation of torso
Origin and Insertion and Action of:
2. Internal Oblique
O: Lumbar fascia, anterior 2/3 iliac crest, lateral 2/3 inguinal ligament
I: ribs 10-12, linea alba and pubic crest via conjoint tendeon
A: compress abdomen, unilateral contraction rotates vertebral column to the same side
Nerve supply abdominal muscles
- RA and EO - lower 6th thoracic nerves
- IO and TA - lower 6th thoracic nerves and ilio-hypogastric and ilio-inguinal nerves
Where does a spigellian hernia emerge?
- Lateral part of rectus sheath at the level of arcuate line
- AKA lateral ventral hernia
- Through spigelian fascia, aponeurotic layer between the rectus abdominis muscle medially and semilunar line laterally
- Small and high risk of strangulation and usually on right side
What is the inguinal canal?
It is on oblique muscular canal in the abdominal wall connecting the intra-abdominal pre-peritoneal space at the deep inguinal ring to the superficial inguinal ring beneath the skin of the pubis
What are the boundaries of the inguinal canal
(MALT)
ROOF - arching fibres of IO and TA Muscle
ANT - EOA
FLOOR inguinal Ligament + lacunar ligament
POST - Transversalis fascia, conjoint Tendon
Define Superficial inguinal ring
- Superficial inguinal ring -defect in the inguinal ligament, it lies above and medial to the PT. triangular opening in the anterior abdominal wall, formed within aponeurosis of EOM, that forms exit of inguinal canal, which houses the ilioinguinal nerve, genital branch of the genitofemoral nerve and spermatic cord/round ligament.
Define Deep inguinal ring
Deep inguinal ring - entrance of inguinal canal, defect in TF, lies 1cm above the midpoint of the inguinal ligament (1/2 ASIS and PT), immediately lateral to the inferior epigastric artery
Contents of the inguinal canal
Spermatic cord / round ligament, ilioinguinal nerve
What are the components of the spermatic cord
3 nerves - ilioinguinal (sits on top), genital br of genitofemoral nerve, sympathetic nerve fibres
3 arteries - testicular artery, artery to vas, cremasteric artery
3 others - vas deferens, pampiniform plexus, lymphatics
3 layers: Ext spermatic fascia, cremasteric fascia/muscle and internal spermatic fascia
Anatomical differences: Direct hernia vs Indirect
- Indirect: persistence processus vaginalis, hernia enters via deep ring, through inguinal canal -> superficial ring through to scrotum if large, and is lateral to IEA
- Direct: weakness in posterior wall of canal, medial to IEA through hesselbachs triangle
Define Mid-inguinal point:
1/2 way between ASIS and PS, surface marking of femoral artery (more medial to MPIL)
Define Midpoint inguinal ligament:
1/2 between ASIS to PT, 1cm superior to you will find the deep ring
What methods of hernia repair do you know of
- Laparoscopic- preperitoneal vs intraperitoneal
- Mesh repair - (Lichtenstein repair) prolene mesh to reinforce posterior wall of canal. #1
- Mesh plug repair - praline mesh plug to occlude deep ring
- Bassini repair - oppose conjoint tendon and inguinal ligament. Repair under tension, with releasing incision prior
- Darn repair - reinforce post wall with darn of non-absorbable sutures between conjoint tendon and inguinal ligament
- Shouldice repair
