INGUINAL CANAL

OBJECTIVES Definition Extent Boundaries Structures passing through the canal Protecting mechanism Applied aspects

DEFINITION Oblique passage in the lower part of the anterior abdominal wall,situated just above the inguinal ligament.

EXTENSION – Deep inguinal ring to Superficial inguinal ring LENGTH – About 4cm EXTENSION – Deep inguinal ring to Superficial inguinal ring Deep inguinal ring Superficial inguinal ring

PECULIARITIES In females canal is narrow In newborns the canal is directed almost straight

ANTERIOR ABDOMINAL WALL

SUPERFICIAL INGUINAL RING. Hiatus in the external oblique aponeurosis. Triangular in shape. Base is the crest of the pubis. Sides are the margins of the opening in the aponeurosis(crura). The lateral crus is stronger

The medial crus is thin,flat band attached to the front of the pubis and interlacing with the opposite crus. Intercrural fibres -Some of the fibres of investing fascia of external obliqe,arch above the apex of superficial inguinal ring as intercrural fibres.

DEEP INGUINAL RING. Situated in transversalis fascia, about 1.25cm above the mid inguinal point,lateral to the stem of inferior epigastric artery.

BOUNDARIES OF INGUINAL CANAL. ANTERIOR WALL IN ITS WHOLE EXTENT Skin Superficial fascia External oblique aponeurosis IN LATERRAL ONE-THIRD Fibres of internal oblique

BOUNDARIES OF INGUINAL CANAL POSTERIOR WALL ENTIRELY FORMED BY Fascia transversalis MEDIAL-HALF Conjoint tendon MEDIAL ONE -FOURTH Reflected part of inguinal ligament

Transversus abdominis roof Arched 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. Internal oblique Grooved surface

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

INGUINAL TRIANGLE OF HESSELBACH. Peritoneal triangle in the posterior wall of the inguinal canal. BOUNDARIES Lateral – Inferior epigastric artery. Medial – Lateral border of rectus abdominis. Inferior – Inguinal ligament.

DEFENSIVE MECHANISM OF INGUINAL CANAL 1) Obliquity of the canal Deep and superficial rings are at different planes 2) Guarding-mechanism Opposite to the deep ring : anterior wall is 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. 3) Slit-valve mechanism Due to approximation of the two crura of the superficial inguinal ring.

4) 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.

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, cremaster muscle contracts and pulls the testis towards the superficial ring.

HERNIA

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

Increase in intra abdominal pressure due to: ETIOLOGY OF HERNIA Increase in intra abdominal pressure due to: Persistent cough Straining Smoking

INGUINAL HERNIA INDIRECT DIRECT

INDIRECT DIRECT

INDIRECT INGUINAL A) Bubunocele B) Funicular C) Complete

TREATMENT Herniotomy Herniorraphy Hernioplasty Open method Laparoscopic method