Inguinal Region

Question 1

Oval opening in transversalis fascia

Lateral to inferior epigastric artery

Answer 1

Deep inguinal ring

Question 2

Triangular opening in external oblique muscle

Lateral to pubic tubercle

Answer 2

Superficial inguinal ring

Question 3

Begins from deep to superficial inguinal ring

Transmit the following structures:

• spermatic cord (males)
• round ligament of the uterus (female)

Answer 3

Inguinal canal

Question 4

Protrudes directly through anterior abdominal wall within Hesselbach triangle

Medial to inferior epigastric vessels

Older males, rare in women

Protrudes on straining, disappears at rest

Felt with pulp of the finger

Answer 4

Direct inguinal hernia

Question 5

Protrudes through the deep inguinal ring –> enters inguinal canal –> superficial inguinal ring (exit) –> scrotum

Lateral to inferior epigastric vessels

Above & medial to the pubic tubercle

Young males

Tender, painful mass that continues into the scrotum

Felt with tip of the finger

Answer 5

Indirect inguinal hernia

Question 6

Protrudes through femoral canal below the inguinal ligament

Below & lateral to the pubic tubercle

Medial to femoral vein

More common in females, appears on right side

Prone to early strangulation

Answer 6

Femoral inguinal hernia

Question 7

Surgical repairs of hernias

Answer 7

Bassini repair

McVay repair (Cooper ligament repair)

Question 8

Transversalis fascia & conjoint tendon are sutured to inguinal ligament (Poupart’s ligament)

Answer 8

Bassini repair

Question 9

Transversalis fascia & conjoint tendon are sutured to Cooper’s ligament (pectineal ligament)

Answer 9

McVay repair (Cooper ligament repair)

Question 10

Surgical repair may damage the ff nerves:

Answer 10

Iliohypogastric nerve
- anesthesia of ipsilateral abdominal wall & inguinal region

Ilioinguinal nerve
- anesthesia of ipsilateral penis, scrotum & medial thigh

Question 11

Layers of abdominal wall

Answer 11

Skin

Superficial fascia
(Camper & Scarpa)

Superficial perineal space (extravasated urine)

External oblique muscle

Internal oblique muscle

Transverse abdominis muscle

Transversalis fascia

Extraperitoneal fat

Parietal peritoneum

Question 12

Coverings of testes & spermatic cord

Answer 12

Skin

COLLE’S fascia & Dartos muscle

Superficial perineal space (extravasated urine)

External spermatic fascia

Cremasteric fascia & muscle

Does not continue into scrotal area

Internal spermatic fascia

Extraperitoneal fat

Tunica vaginalis

Question 13

Testis fails to descend into scrotum, testis may be found in inguinal canal or abdominal cavity

Answer 13

Cryptorchidism

Question 14

Small patency of processus vaginalis allows peritoneal fluid to flow into –> fluid filled cyst

Answer 14

Hydrocele

Question 15

Metastasize to superficial inguinal nodes

Answer 15

Scrotal cancer

Question 16

Metastasize to deep lumbar nodes near renal hilus

Answer 16

Testicular cancer

Question 17

Extravasated urine from saddle injury –> leak into superficial perineal space between COLLE’S fascia & Dartos muscle & external spermatic fascia

Answer 17

Trauma

Question 18

Vasectomy citrus through the ff:

Answer 18

Skin –> COLLE’S fascia & Dartos muscle –> external spermatic fascia –> cremasteric fascia & muscle –> internal spermatic fascia –> extraperitoneal fat

• Tunica Vaginalis is not cut

Question 19

Cold lower border of external oblique muscle

From ASIS to pubic tubercle

Answer 19

Inguinal ligament