Inguinal Region Anatomy PDF

INGUINAL REGION Dr. Aiman Qais Afar Surgical Anatomist College of Medicine / University of Fallujah 2022-2023 1 Inguinal Region The inguinal region (groin) extending between the ASIS and pubic tuber...

INGUINAL REGION Dr. Aiman Qais Afar Surgical Anatomist College of Medicine / University of Fallujah 2022-2023 1 Inguinal Region The inguinal region (groin) extending between the ASIS and pubic tubercle, is an important area anatomically and clinically.  Anatomically because it is a region where structures exit and enter the abdominal cavity and  Clinically because the pathways of exit and entrance are potential sites of herniation. Dr. Aiman Qais Afar 2 Inguinal Region In fact, the majority of abdominal hernias occur in this region, with inguinal hernias in particular accounting for 75% of all abdominal hernias,(approximately 86%) occur in males because of the passage of the spermatic cord through the inguinal canal. Dr. Aiman Qais Afar 3 Inguinal Canal  The inguinal canal is an oblique passage through the lower part of the anterior abdominal wall. In the males, it allows structures to pass to and from the testis to the abdomen. In females it allows the round ligament of the uterus to pass from the uterus to the labium majus. Dr. Aiman Qais Afar 4 Inguinal Canal The canal is about 1.5 in. (4 cm) long in the adult and extends from the deep inguinal ring, a hole in the fascia transversalis downward and medially to the superficial inguinal ring, a hole in the aponeurosis of the external oblique muscle Dr. Aiman Qais Afar 5 Inguinal Canal The deep inguinal ring, an oval opening in the fascia transversalis, lies about 0.5 in. (1.3 cm) above the inguinal ligament midway between the anterior superior iliac spine and the symphysis pubis Related to it medially are the inferior epigastric vessels, which pass upward from the external iliac vessels The margins of the ring give attachment to the internal spermatic fascia Dr. Aiman Qais Afar 6 Inguinal Canal The superficial inguinal ring is a triangular-shaped defect in the aponeurosis of the external oblique muscle and lies immediately above and medial to the pubic tubercle The margins of the ring, sometimes called the crura, give attachment to the external spermatic fascia Dr. Aiman Qais Afar 7 Walls of the Inguinal Canal Anterior wall Posterior wall Roof Floor Dr. Aiman Qais Afar 8 Walls of the Inguinal Canal wall: External oblique Anterior aponeurosis, reinforced laterally by the origin of the internal oblique from the inguinal ligament Posterior wall: Conjoint tendon medially, fascia transversalis laterally. Roof or superior wall: Arching lowest fibers of the internal oblique and transversus abdominis muscles Floor or inferior wall: Upturned lower edge of the inguinal ligament and, at its medial end, the lacunar ligament Dr. Aiman Qais Afar 9 Walls of the Inguinal Dr. Aiman Qais Afar Canal Anterior wall is therefore strongest where it lies opposite the weakest part of the posterior wall, namely, the deep inguinal ring. Posterior wall is therefore strongest where it lies opposite the weakest part of the anterior wall, namely, the superficial inguinal ring 10 Spermatic Cord Is a collection of structures that pass through the inguinal canal to and from the testis. It begins at the deep inguinal ring lateral to the inferior epigastric artery and ends at the testis. Structures of the Spermatic Cord Vas deferens Testicular artery Testicular veins (pampiniform plexus) Testicular lymph vessels Autonomic nerves Remains of the processus vaginalis Genital branch of the genitofemoral nerve, which supplies the cremaster muscle Dr. Aiman Qais Afar 11  Vas Deferens (Ductus Dr. Aiman Qais Afar Deferens) Is a cordlike structure that can be palpated between finger and thumb in the upper part of the scrotum.  It is a thick-walled muscular duct that transports spermatozoa from the epididymis to the urethra Vasectomy ??? 12 Testicular Artery A branch of the abdominal aorta (at the level of the second lumbar vertebra), the testicular artery is long and slender and descends on the posterior abdominal wall. It traverses the inguinal canal and supplies the testis and the epididymis Dr. Aiman Qais Afar 13  Dr. Aiman Qais Afar Testicular Veins An extensive venous plexus, the pampiniform plexus, leaves the posterior border of the testis as the plexus ascends, it becomes reduced in size so that at about the level of the deep inguinal ring, a single testicular vein is formed. This runs up on the posterior abdominal wall and drains into the left renal vein on the left side and into the inferior vena cava on the right side 14 Processus Vaginalis The remains of the processus Vaginalis are present within the cord Hydrocele of Spermatic Cord and/or Testis ???? Dr. Aiman Qais Afar 15 Coverings of the Spermatic Cord (the Spermatic Fasciae) External spermatic fascia derived from the external oblique aponeurosis and attached to the margins of the superficial inguinal ring Cremasteric fascia derived from the internal oblique muscle Internal spermatic fascia derived from the fascia transversalis and attached to the margins of the deep inguinal ring Dr. Aiman Qais Afar 16  Dr. Aiman Qais Afar Scrotum The scrotum is an outpouching of the lower part of the anterior abdominal wall and contains the testes, the epididymides, and the lower ends of the spermatic cords. 17  Dr. Aiman Qais Afar Scrotum The wall of the scrotum has the following layers: Skin Superficial fascia; The dartos muscle, replaces the fatty (camper fascia), and The membranous layer (Scarpa's fascia) is now called Colles' fascia. External spermatic fascia derived from the external oblique Cremasteric fascia derived from the internal oblique 18  Scrotum The wall of the scrotum: Internal spermatic fascia derived from the fascia transversalis Tunica vaginalis, which is a closed sac that covers the anterior, medial, and lateral surfaces of each testis Dr. Aiman Qais Afar 19  Dr. Aiman Qais Afar Testi sThe testis is a firm, mobile organ lying within the scrotum.  The left testis usually lies at a lower level than the right. Each testis is surrounded by a tough fibrous capsule, the tunica albuginea 20  Testi sExtending from the inner surface of the capsule is a series of fibrous septa that divide the interior of the organ into lobules.  Lying within each lobule are one to three coiled seminiferous tubules. The tubules open into a network of channels called the rete testis. Small efferent ductules connect the rete testis to the upper end of the epididymis Dr. Aiman Qais Afar 21 Epididymis  The epididymis is a firm structure lying posterior to the testis, with the vas deferens lying on its medial side.  It has an expanded upper end, the head, a body, and a pointed tail inferiorly.  Laterally, a distinct groove lies between the testis and the epididymis, which is lined with the inner visceral layer of the tunica vaginalis and is called the sinus of the epididymis. Dr. Aiman Qais Afar 22  Blood Supply of the Testis and Epididymis The testicular artery is a branch of the abdominal aorta. The testicular veins emerge from the testis and the epididymis as a venous network, the pampiniform plexus. This becomes reduced to a single vein as it ascends through the inguinal canal. The right testicular vein drains into the inferior vena cava, and the left vein joins the left renal vein. Varicocele ???? Dr. Aiman Qais Afar 23 Formation of the inguinal canals and descent of testes Dr. Aiman Qais Afar 24  Dr. Aiman Qais Afar  A hernia is the protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall.  Indirect Inguinal Hernia : The sac enters the inguinal canal through the deep inguinal ring lateral to the inferior epigastric vessels. (the most common 85%)  Direct Inguinal Hernia : The sac of a direct hernia bulges directly anteriorly through the posterior wall of the inguinal canal medial to the inferior epigastric vessels (about 15%) 25 The inguinal hernia form about 75% of all abdominal wall hernias( Femoral, Umbilical, Incisional ,Epigastric…etc.) Dr. Aiman Qais Afar 26 Indirect Inguinal Hernia It is the remains of the processus vaginalis and therefore is congenital in origin. It is more common than a direct inguinal hernia. It is much more common in males than females. It is more common on the right side. It is most common in children and young adults. The hernial sac enters the inguinal canal through the deep inguinal ring and lateral to the inferior epigastric vessels. The neck of the sac is narrow. The hernial sac may extend through the superficial inguinal ring above and medial to the pubic tubercle. (Femoral hernia is located below and lateral to the pubic tubercle) The hernial sac may extend down into the Dr. Aiman Qais Afar 27 scrotum or labium majus Direct Inguinal Hernia A direct inguinal hernia can be summarized as follows: It is common in old men with weak abdominal muscles and is rare in women. The hernial sac bulges forward through the posterior wall of the inguinal canal medial to the inferior epigastric vessels. The neck of the hernial sac is wide. Dr. Aiman Qais Afar 28 Dr. Aiman Qais Afar 29 Dr. Aiman Qais Afar Surgical Anatomist Dr. Aiman Qais Afar 30