General Anatomy

INGUINAL
ANATOMY
Anatomy Group
Dr Naser Radwan, MD
Dr Amjad Abu Alqumboz, MD
Dr Adham AlZanoun, MD
INGUINAL CANAL
• Is an Oblique passage through the lower part of the
anterior abdominal wall and is present in both sexes.
• It allows structures to pass to and from the testis to
the abdomen in males.
INGUINAL CANAL
• In females it permits the passage of the Round
Ligament of Uterus (from uterus to labium magus).
• It transmits the ilioinguinal nerve LI in both sexes.
• The canal is about
(4 cm) long in adult
and extends from
Deep Inguinal Ring
downward and
medially to the
Superficial Inguinal
Ring.

• It lies parallel to and

immediately above
the inguinal
ligament.
• In the newborn
child, the deep ring
lies almost directly
posterior to the
superficial ring so
that the canal is
considerably shorter
at this age.

• Later, as the result

of growth, the deep
ring moves laterally.
• The deep inguinal ring, an oval opening in the
Fascia Transversalis, lies about (1.3 cm) 0.5 inch
above the inguinal ligament midway between the
anterior superior iliac spine and the pubic tubercle.
Medial to deep ring are Inferior Epigastric Vessels ,
which pass upward from the external iliac vessels.
The margins of the ring give attachment to the
internal spermatic fascia.
 Walls of inguinal Canal
Anterior wall of canal
• Is formed along its entire
length by the aponeurosis
of External Oblique Muscle.
• It is reinforced in its lateral
third by the origin of the
Internal Oblique from the
inguinal ligament.
• This wall is therefore
strongest where it lies
opposite the weakest part
of the posterior wall,
namely, the deep inguinal
ring.
 Walls of inguinal Canal

Anterior
wall of
canal
 Walls of inguinal Canal
Posterior wall of canal
• Is formed along Its entire
length by Fascia
Transversalis
• It is reinforced in its
medial third by Conjoint
Tendon.

• This wall is therefore strongest where lies opposite the

weakest part of the anterior wall, namely, the
superficial inguinal ring.
 Walls of inguinal Canal
Inferior wall of cana
(Floor)

• Is formed by the
Inguinal ligament
and, at its medial
end, the lacunar
ligament.
 Walls of inguinal Canal
Superior wall of canal
(Roof)
• Is formed by the
arching lowest
fibers of the
internal oblique
and transversus
abdominis
muscles.
 Walls of inguinal Canal/SUMMRY
•Anterior wall: External oblique aponeurosis,
origin of the internal oblique, inguinal ligament.
•Posterior wall: Conjoint tendon medially,
fascia transversalis laterally.
•Superior wall (Roof): Arching lowest fibers of
the internal oblique and transversus abdominis
muscles.
•Inferior wall (floor): Upturned lower edge of
the inguinal ligament and, at its medial end, the
lacunar ligament.
 Function of the inguinal Canal
• The inguinal canal allows structures of the Spermatic
Cord to pass to and from the testis to the abdomen
in the male.

• Normal spermatogenesis takes place only if the

testis leaves the abdominal cavity to enter a cooler
environment in the scrotum.

• In the female, the smaller canal permits the passage

of the Round ligament of the uterus from the uterus
to the labium majus.

• In both sexes, the canal transmits Ilioinguinal Nerve.

Mechanics of the Inguinal Canal

The presence of the inguinal canal in the

lower part of the anterior abdominal
wall in both sexes constitutes a
potential weakness, It is interesting to
consider how the design of this
canal attempts to decrease this weakness.
• Except in the Newborn
infant, the canal is an
oblique passage with the
weakest areas, namely, the
superficial and deep rings,
lying some distance apart.
• The anterior wall of the
canal is reinforced by the
fibers of the internal
oblique muscle
immediately in front of the
deep ring.
• The posterior wall of the canal
is reinforced by the Strong
Conjoint Tendon immediately
behind the superficial ring.
• On coughing and straining, the
arching lowest fibers of the
internal oblique and
transversus abdominis muscles
contract, flattening out the
arched roof so that it is lowered
toward the floor, The roof may
actually compress the contents
of the canal against the floor so
that the canal is virtually closed.
 Structures which pass through the canal
• In males: spermatic cord & its coverings + ilioinguinal nerve.
• In females: round ligament of uterus + ilioinguinal nerve.
•The classic description of contents of spermatic cord in males:
•3 arteries: artery to vas deferens , testicular artery , cremasteric
artery
•3 fascial layers: external spermatic, cremasteric , and internal
spermatic fascia
•3 other structures:pampiniform plexus, vas deferens(ductus
deferens), testicular lymphatics;
•3 nerves: genital branch of the genitofemoral nerve(L1/2),
sympathetic and visceral afferent fibers, ilioinguinal nerve (N.B.
outside spermatic cord but travels next to it)
•Ilioinguinal nerve passes through the superficial ring to descend
into the scrotum, does not formally run through the canal.
 Important surface anatomy
• Mid point of inguinal ligament:
-Midway between ASIS and pubic tubercle.
- It is an important surgical landmark of the deep
inguinal ring, that lies 0.5 inches above it.

• Mid-inguinal point:
-This is half way between ASIS and symphysis pubis
- It is the landmark for the femoral artery.
 Hesselbach’s Triangle
• It is a part of the posterior
wall of the inguinal canal.

• It is the triangle through

which direct inguinal hernia
passes.

• It is bounded by:
- Laterally: inferior epigastric vessels.
- Medially: Lateral border of rectus sheath.
- Inferior: inguinal ligament (only medial ½)
 ABDOMINAL HERNIA
• A Hernia is the protrusion of part of the abdominal
contents beyond the normal confines of the
abdominal wall.
Parts of
hernia

contents of coverings of
sac
the sac the sac

neck body
 ABDOMINAL HERNIA
• Groin Hernia
• Inguinal (indirect or direct).
• Femoral.
• Ventral hernias
• Umbilical (congenital or acquired).
• Epigastric.
• Separation of the recti abdominis.
• Incisional hernia.
• Hernia of the linea Semilunaris
(Spigelian hernia).
• Internal hernia.
• Diaphragmatic
 INDIRECT INGUINAL HERNIA

•is the most common form

of hernia and is believed
to be congenital in origin.
•The Hernial sac is the
remains of the processus
vaginalis.
•It follows that the sac
enters the inguinal canal
through the Deep Inguinal
Ring lateral to the Inferior
epigastric vessels .
 INDIRECT INGUINAL HERNIA

• It may extend part of the way along the canal or the

full length, as far as the superficial inguinal ring.

• If the processus vaginalis has under gone no

obliteration, then the hernia is complete and extends
through the superficial inguinal ring (above and
medial to the pubic tubercle) down into the scrotum.

• Under these circumstances the neck of the hernial

sac lies at the deep inguinal ring lateral to the
inferior epigastric vessels.
Rt and Lt indirect Inguinal Hernia
 DIRECT INGUINAL HERNIA
• About 15% of all inguinal
hernias.
•The sac of a direct hernia
bulges directly anteriorly
through the posterior wall
of the inguinal canal
medial to the inferior
epigastric vessels.
•Because of the presence of
the strong conjoint tendon
this hernia is usually
nothing more than a
Generalized bulge;
therefore, the Neck of the
hernia sac is wide.
DIRECT INGUINAL HERNIA
 DIRECT INDIRECT
Old Usually young Age
Acquired May be Cause
congenital
50% 20% Bilateral
Straight oblique Protrusion on
cough
Does reach Does not reach Appearance
full size on standing
immediately
Reduce May not reduce Reduction on
lying down
 DIRECT INDIRECT

Wide Narrow Neck of sac

Unusual Not strangulation

uncommon
Medial lateral Relation to inferior
epigastric
Rare Common Descent to
scrotum
No control Control Internal ring test
 FEMORAL SHEATH
• is a protrusion of the fascial envelope lining the
abdominal walls and surrounds the femoral vessels
and lymphatics for about (2.5 cm) below the inguinal
ligament.
 FEMORAL SHEATH
• The femoral artery, as it enters the thigh below the inguinal
ligament, occupies the lateral compartment of the sheath.
• The femoral vein, which lies on its medial side and is
separated from it by a fibrous septum, occupies the
intermediate compartment.
• The lymph vessels, which ore separated from the vein by a
fibrous septum, occupy the most medial compartment.
 FEMORAL CANAL
• The femoral canal, the
compartment for the
lymphatics, occupies
the medial part of the
sheath.

• It is about (1.3 cm) long,

and its upper opening is
referred to as the
Femoral Ring.
 FEMORAL HERNIA
• The hernia sac descends
through the femoral canal
within the femoral sheath,
creating a femoral hernia.
• A femoral hernia is More
Common in Women than in
men (possibly because of a
wider pelvis and femoral
canal).
• The hernial sac passes down
the femoral canal, pushing the
femoral septum before it.
 FEMORAL HERNIA
On escaping through the
lower end, it expands to form a
swelling in the upper part of
the thigh deep to the deep
fascia.

With further expansion, the

hernial sac may turn upward to
cross the anterior surface of
the inguinal ligament.
 FEMORAL HERNIA
• The neck of the sac is Narrow and lies at femoral ring.
•Once an abdominal viscus has passed through the neck
into the body of the sac, it may be difficult to push it up
and return it to the abdominal cavity (Irreducible
Hernia).
• Furthermore, alter straining or coughing, a piece of
bowel may be forced through the neck and its blood
vessels may be compressed by the femoral ring,
seriously impairing its blood supply (Strangulated
hernia).
• A femoral hernia is a dangerous disease and Should
Always be Treated Surgically.