Groin Anatomy PDF

GROIN Prepared by : Dr.Abdinor Arab The groin (inguinal region) is the area of junction between the anterior abdominal wall and the thigh. In this area, the abdominal wall is weakened from changes that occur during development and a peritoneal sac or diverticulum, with or without...

GROIN Prepared by : Dr.Abdinor Arab The groin (inguinal region) is the area of junction between the anterior abdominal wall and the thigh. In this area, the abdominal wall is weakened from changes that occur during development and a peritoneal sac or diverticulum, with or without abdominal contents, can therefore protrude through it, creating an inguinal hernia.  This type of hernia can occur in both The inherent weakness in the anterior abdominal wall in the groin is caused by changes that occur during the development of the gonads (the testes and ovaries). A peritoneal outpouching (the processus vaginalis) forms protruding through the various layers of the anterior abdominal wall and acquiring coverings from each: 1.The transversalis fascia forms its deepest covering. 2.The second covering is formed by the musculature of the internal oblique. 3.Its most superficial covering is the As a result the processus vaginalis is transformed into a tubular structure with multiple coverings from the layers of the anterior abdominal wall. This forms the basic structure of the inguinal canal. The processus vaginalis is immediately anterior to the gubernaculum within the inguinal In men, as the testes descend, the testes and their accompanying vessels, ducts, and nerves pass through the inguinal canal and are therefore surrounded by the same fascial layers of the abdominal wall. Testicular descent completes the formation of the spermatic cord in men. In women, the ovaries descend into the pelvic cavity and become associated with the developing uterus. Therefore, the only remaining structure passing through the inguinal canal is the  INGUINAL CANAL The inguinal canal is a slit-like passage that extends in a downward and medial direction, just above and parallel to the lower half of the inguinal ligament.  It begins at the deep inguinal ring and continues for approximately 4 cm, ending at the superficial inguinal ring. The contents of the canal are the genital branch of the genitofemoral nerve, the spermatic cord in men, and the round ligament of the uterus in women Deep inguinal ring The deep (internal) inguinal ring is the beginning of the inguinal canal and is just above the inguinal ligament and immediately lateral to the inferior epigastric vessels. Superficial inguinal ring The superficial (external) inguinal ring is the end of the inguinal canal and is superior to the pubic tubercle. It is a triangular opening in the aponeurosis of the external oblique, with its apex pointing superolaterally and its base formed by the pubic crest. The two remaining sides of the triangle (the medial crus and the lateral crus) are attached to the pubic symphysis and the pubic tubercle, respectively.  At the apex of the triangle the two crura are held together by crossing (intercrural) fibers, which prevent further widening of the superficial ring.  ANTERIOR WALL The anterior wall of the inguinal canal is formed along its entire length by the aponeurosis of the external oblique muscle. It also contributes a layer (the cremasteric fascia containing the cremasteric muscle) to the coverings of the structures traversing the inguinal canal.  POSTERIOR WALL The posterior wall of the inguinal canal is formed along its entire length by the transversalis fascia. It is reinforced along its medial one-third by the conjoint tendon (inguinal falx ).  ROOF The roof (superior wall) of the inguinal canal is formed by the arching fibers of the transversus abdominis and internal oblique muscles. FLOOR The floor (inferior wall) of the inguinal canal is formed by the medial one-half of the inguinal ligament  CONTENTS  The contents of the inguinal canal are: 1.The spermatic cord in men, and 2.The round ligament of the uterus and genital  SPERMATIC CORD The spermatic cord begins to form proximally at the deep inguinal ring and consists of structures passing between the abdominopelvic cavities. The structures in the spermatic cord include: 1.The ductus deferens. 2.The artery to the ductus deferens (from the inferior vesical artery) 3.The testicular artery (from the 4. The genital branch of the genitofemoral nerve (innervation to the cremasteric muscle), 5. Sympathetic and visceral afferent nerve fibers, 6. Lymphatics, and 7. Remnants of the processus  INGUINAL HERNIAS An inguinal hernia is the protrusion or passage of a peritoneal sac, with or without abdominal contents, through a weakened part of the abdominal wall in the groin.  It occurs because the peritoneal sac enters the inguinal canal either: 1.Indirectly, through the deep inguinal ring, or  INDIRECT INGUINAL HERNIAS The indirect inguinal hernia is the most common of the two types of inguinal hernia and is much more common in men than in women. It occurs because some part, or all, of the embryonic processus vaginalis remains open or patent. It is therefore referred to as being congenital in  DIRECT INGUINAL HERNIAS A peritoneal sac that enters the medial end of the inguinal canal directly through a weakened posterior wall is a direct inguinal hernia. It is usually described as acquired because it develops when The bulging occurs medial to the inferior epigastric vessels in the inguinal triangle (Hesselbach’s triangle), which is bounded: 1.Laterally by the inferior epigastric artery, 2.Medially by the rectus abdominis muscle, and 3.Inferiorly by the inguinal