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GOOD MORNING

This informative article provides a detailed analysis of the inguinal canal, including its boundaries, contents, and development. It also explores the defensive mechanisms and applied anatomy of this crucial anatomical structure.

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GOOD MORNING

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  1. GOOD MORNING

  2. INGUINAL CANAL

  3. INTRODUCTION DEVELOPMENT BOUNDARIES CONTENTS DEFENSIVE MECHANISM APPLIED ANATOMY TREATMENT REFERENCES

  4. ANTERIOR ABDOMINAL WALL External oblique muscle Skin Superficial fascia Fascia transversalis

  5. INGUINAL LIGAMENT: • Lower border of the External oblique aponeurosis is folded on itself forming the inguinal ligament. • Extends between the anterior superior iliac spine and the pubic tubercle. Inguinal ligament

  6. Presents grooved upper surface. • Measures about 12-14 cm in the adults. • Medial end it presents 3 expansions: 1. Lacunar ligament 2. pectineal ligament of cooper. 3. Reflected part of inguinal ligament.

  7. LACUNAR LIGAMENT: • Triangular in shape. • Apex: Formed by pubic tubercle. Base: Free, concave . Upper surface forms a part of the floor of the inguinal canal.

  8. PECTINEAL LIGAMENT OF COOPER • Fibrous band extending laterally from the base of the lacunar ligament • Attached to pecten pubis upto the ilio-pubic eminence.

  9. REFLECTED PART OF INGUINAL LIGAMENT • At the medial end some fibers pass upwards and medially behind the superficial inguinal ring to join the linea alba. • Fibers from either side decussate in the linea alba. • Third crus of the superficial inguinal ring. Reflect part of inguinal ligament

  10. INGUINAL CANAL Deep inguinal ring Superficial inguinal ring

  11. A musculo -aponeurotic tunnel. • Extent: Deep inguinal ring to superficial inguinal ring. • Directed downwards forwards and medially. • Location: Above and parallel to the medial half of the inguinal ligament. Inguinal canal

  12. Length: About 4cm. • Narrow, in females. • In newborns: straight forwards, because the anterior abdominal muscles are not properly differentiated Spermatic cord

  13. DEVELOPMENT OF INGUINAL CANAL GUBERNACULUM: Condensation of the band of mesoderm, extending from the lower pole of the developing gonad through the inguinal canal to the labioscrotal swelling . • Inguinal canal represents the passage of the gubernaculum through the abdominal wall. • The canal is short in early life, as pelvis increases in width, the deep ring is shifted laterally.

  14. As the gubernaculum shortens, it pulls the testis along with the processus vaginalis. • Processus vaginalis is a peritoneal pouch in which testis project. • At 4th month of intrauterine life, testis appear in iliac fossa

  15. 7th month : reaches the deep inguinal ring. • 8th month: traverses the inguinal canal. • Finally reaches scrotum at or slightly after birth. • Processus vaginalis distal part: persists as closedvaginal sac. Proximal part: obliterates and dissapears .

  16. CONTENTS 1)Spermatic cord in males; round ligament of the uterus in females. 2)Ilio-inguinal nerve in both sexes Spermatic cord Ilio-inguinal nerve

  17. BOUNDARIES OF THE CANAL Canal presents : • Inlet • Outlet. • Anterior and posterior walls • Roof • Floor

  18. INLET Formed by deep inguinal ring • Oval or ‘U-shaped’ opening in the fascia transversalis. • Lies about 1.25 cm above the mid inguinal point . • Bounded by superior and inferior crura. Deep ring

  19. Tranversus abdominis Relations of the deep ring : Above: arched fibers of transversus abdominis muscle. In front and laterally:Internal oblique. Medially: a) Inferior epigastric artery, behind the fascia transversalis. b) Sometimes the inter-foveolar ligament. Internal oblique Inferior epigastric artery

  20. OUTLET Formed by the superficial inguinal ring • Triangular gap • Above and lateral to pubic crest. Structures passing through: • Ilio-inguinal nerve b) Spermatic cord or round ligament. Superficial ring

  21. Margins are called as crura. • Lateral crus-stronger,reinforced by the fibers of the inguinal ligament inserted into the pubic tubercle. • Medial crus is thin. Superficial ring

  22. Measurements: Apex to base- 2.5cm At the base-1.25cm Boundaries : Base : Pubic crest Apex: Convergence of the two crura, kept in position by the inter-crural fibres of external oblique. Medially: Medial crus,attached to symphysis pubis. Laterally: Lateral crus, fixed to the pubic tubercle.

  23. ANTERIOR WALL • Entirely formed by skin, superficial fascia and external oblique aponeurosis. • lateral one-third : fleshy fibers of internal oblique.

  24. POSTERIOR WALL • Entirely formed by the fascia transversalis. • Partially formed: medial half: by the conjoint tendon in front of the fascia transversalis. In medial one fourth by the reflected part of inguinal ligament in front of the conjoint tendon Fascia transversalis Reflected part of ingunal ligament

  25. ROOF Arching lowest fibers of the internal oblique and transversus abdominis muscle. FLOOR Grooved upper surface of the inguinal ligament, Medial end: upper surface of the lacunar ligament. Grooved upper surface

  26. INGUINAL TRIANGLE OF HASSELBACH • A peritoneal triangle in the posterior wall of inguinal canal. Boundries: Laterally-Inferior epigastric artery Medially-lateral border of rectus abdominis. Below-inguinal ligament. • Divided by obliterated umbilical artery into supra-vesical fossa and medial inguinal fossa.

  27. CONTENTS IN DETAIL SPERMATIC CORD • Collection of structures that pass through inguinal canal .

  28. Structures: • Vas deferens • Testicular artery and veins. • Testicular lymph vessels • Autonomic nerves • Remains of Processus vaginalis. • Genital branch of genitofemoral nerve • Cremasteric artery • Artery to vas deferens

  29. VAS DEFERENS (DUCTUS DEFERENS) • Cord-like structure. • Thick-walled muscular duct , transports spermatozoa from the epididymis to urethra through ejaculatory duct. • Runs in the posterior part of spermatic cord to the deep inguinal ring • Hooks around the lateral side of inferior epigastric artery.

  30. TESTICULAR ARTERY • Branch of abdominal aorta. • Long, slender and descends on the posterior abdominal wall. • Traverses inguinal canal , supplies testis and epididymis.

  31. TESTICULAR VEINS • Pampiniform plexus leaves the posterior border of testis. • Superficial inguinal ring : unite to form four veins. • Deep inguinal ring : A single testicular vein is formed. • Left side: Left renal vein Right : Inferior vena cava.

  32. LYMPH VESSELS Testicular lymph vessels – lumbar(para-aortic) lymph nodes. AUTONOMIC NERVES Sympathetic fibers from renal or aortic sympathetic plexuses. PROCESSUS VAGINALIS CREMASTERIC ARTERY ARTERY TO VAS DEFERENS GENITAL BRANCH(L2) OF GENITOFEMORAL NERVE

  33. COVERINGS OF SPERMATIC CORD 3 concentric layers of fascia. • Internal spermatic fascia • Cremasteric muscle and fascia • External spermatic fascia

  34. ILIOINGUINAL NERVE • Conveys fibers from ventral rami of L1. • Pierces internal oblique muscle – about 2.5cm below and medial to anterior superior iliac spine. • Superficial to spermatic cord. • Leaves the canal through superficial ring. • Supplies skin on front of thigh and anterior parts of external genitalia.

  35. In females: ROUND LIGAMENT OF UTERUS: • Part of the gubernaculum extending from uterus into labium majus. LYMPH VESSELS • Convey small amount of lymph from body of uterus to superficial inguinal nodes.

  36. DEFENSIVE MECHANISM OF INGUINAL CANAL 1)OBLIQUITY OF THE CANAL Deep and superficial rings are at different planes. 2) FLAP-VALVE The posterior wall of the canal is pushed forwards and comes in contact with the anterior wall , obliterating the canal like a flap valve. 3)GUARDING-MECHANISM Opposite to the deep ring : anterior wall strengthened by fleshy fibers of the internal oblique muscle. Opposite to the superficial ring: posterior wall , by conjoint tendon and reflected part of inguinal ligament.

  37. 4)SLIT-VALVE MECHANISM Due to approximation of the two crura of the superficial inguinal ring. 5) SHUTTER MECHANISM Arched fibers of internal oblique and transversus , act as demi-sphincters. In increased intra abdominal pressure, it obliterate the canal by bringing the roof in contact with the floor. 6) BALL-VALVE ACTION In increased intra-abdominal pressure,cremastermuscle contracts and pulls the testis towards the superficial ring.

  38. CREMASTERIC REFLEX • Cremaster muscle can be made to contract by stroking the skin on the medial aspect of the thigh. • Afferent fibres travel in femoral branch of genitofemoral nerve • Efferent motor fibres: genital branch

  39. HERNIA

  40. An abnormalprotrusion of a viscus or a part of a viscus through a weak point (opening) in the walls of its containing cavity. What is a hernia??

  41. CAUSES OF HERNIA 1)Increase in intra abdominal pressure due to: • Persistent cough • Straining 2)Obesity 3)Intra-abdominal malignancies. 4)Smoking

  42. COMPOSITION OF A HERNIA Consists of 3 parts: 1)Sac • Peritoneal diverticulum • Mouth,neck,body,fundus 2) Contains of the sac 3)Coverings of the sac: derived from the layers of the anterior abdominal wall through which it passes.

  43. TYPES OF HERNIAS OBSTRUCTED • Reducible • Irreducible • Obstructed • Strangulated STRANGULATED

  44. INGUINAL HERNIA

  45. The inguinal canal: a potential cause for herniation. • Inguinal hernia: Protrusion of a viscus through the tissue of the inguinal region. • 2 main types: • Indirect or oblique 2) Direct

  46. INDIRECT OR OBLIQUE INGUINAL HERNIA • Common in the young. • most common of all forms of hernias. • In first decade of life, mostly seen on the right side in the males ; • CANAL OF NUCK : (In females)A small peritoneal pouch in the inguinal canal, that may extend to the labium majus , due to persistent processusvaginalis. • Can enlarge and form cysts and develop into an indirect inguinal hernia

  47. Cause - mainly congenital. Enters through the deep ring. Neck: lateral to the inferior epigastric artery. Hernial sac may extend through the superficial inguinal ring. When complete:reaches the scrotum.

  48. Coverings: 1) Peritoneum of the sac 2) extra-peritoneal tissue 3) Internal spermatic fascia 4) Cremasteric muscle and fascia 5) External spermatic fascia 6) Dartos muscle 7) Skin

  49. TYPES OF OBLIQUE INGUINAL HERNIA 1) COMPLETE / VAGINAL • When processus vaginalis remains patent along the entire extent, hernia reaches the base of the scrotum , in front of testis.

  50. 2) BUBONOCELE • The hernia is limited to the inguinal canal. 3) FUNICULAR • Processus vaginalis is obliterated above the testis , remains patent in the proximal part • Most common type.

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