INGUINAL CANAL

• Definition :-
Musculofascial canal that
pierces obliquely
through AAW, contain
spermatic cord in males,
round ligament of uterus
in females

• Extension –laterally DIR

to medially SIR
 INGUINAL CANAL

• Direction –downward,
forward, medially

• Location –Just 1 cm
above medial half of
inguinal ligament
 INGUINAL RINGS

• Deep inguinal ring

– Oval opening in the
fascia transversalis
– ½ inch above mid-
inguinal point
- Just lateral to inferior
epigastric artery
• Superficial inguinal ring
- Triangular gap in
aponeurosis of EO
- Above and lateral to pubic
tubercle
- 2.5cm long, 1.2 cm broad
- Structures passing –
a. Ilioinguinal nerve
b. Spermatic cord / round lig
 INGUINAL CANAL

Boundaries
• Anterior wall –
- Skin
- Superficial fascia
- Aponeurosis of EO,
- Lateral 1/3 of canal formed
by IO
• Posterior wall –
- Fascia Transversalis
- Conjoint tendon in medial 2/3
- Reflected part of inguinal
ligament in medial most part
• Roof –
- Arched fibres of internal
oblique & transversus
abdominis

• Floor –
- Grooved upper surface of
inguinal ligament
- Lacunar ligament in medial
end
 CONTENTS

• Males
– Spermatic cord
– Ilioinguinal nerve
• Females
– Round ligament
– Ilioinguinal nerve
• Abnormal contents
– Undesended testis
– Intestine
– Suprarenal cortex
– Accessory spleen
 MECHANISMS TO MAINTAIN THE INTEGRITY OF
THE INGUINAL CANAL

 Flap valve mechanism

 Shutter mechanism
 Slit valve mechanism
 Ball valve mechanism
 Guarding of inguinal rings
 MECHANISMS TO MAINTAIN THE INTEGRITY OF
THE INGUINAL CANAL
• Flap valve mechanism

-deep and superficial

inguinal rings do not lie
opposite to each other due
to obliquity of canal

- Rise in intra-abdominal
pressure anterior and
posterior walls of canal
approximated like a flap
• Shutter mechanism
- IO form flex mobile arch around inguinal canal
forming anterior wall, roof, posterior wall
- When IO contracts roof is pulled and approximated
on floor like a shutter
 MECHANISMS TO MAINTAIN THE INTEGRITY OF
THE INGUINAL CANAL

• Slit-valve mechanism

- Contraction of EO
approximates two crura of
SIR like a slit valve
• Ball valve action of
cremaster
- Contraction of
cremaster pulls testis
up
- Spermatic cord plug
SIR
• Guarding of inguinal rings

- deep inguinal ring is guarded

by internal oblique muscle

- Superficial inguinal ring

guarded by conjoint tendon
and reflected part of
inguinal ligament
 Inguinal triangle

- Hesselbach’s triangle
Boundaries
- Medial –lateral border of RA
- Lateral –inferior epigastric
artery
- Inferior – medial ½ inguinal
ligament
- Floor –peritoneum,
extraperitoneal tissue, FT
 INGUINAL HERNIA

• Definition –protrusion of
abdominal viscera into
inguinal canal
• Two types – Direct
Indirect
 Direct inguinal hernia

- Hernial sac entering inguinal

canal directly by posterior wall
of inguinal canal forward
- Medial to inferior epigastric
artery
- Common in elderly due to
weak abdominal muscles
• Indirect inguinal hernia
- Hernial sac enters inguinal canal
through deep inguinal ring
- Lateral to inferior epigastric
artery
- Common in children, young
adults
- Cause –complete or partial
competency of processus
vaginalis
- Indirect is more common than
direct hernia
- More common in males than
females
 Indirect inguinal hernia
• Two types –congenital
-acquired

a. Congenital – patent processus

vaginalis
- Types –
I. Vaginal –processus vaginalis
patent along entire extent
- Hernia reaches base of
scrotum
II. Funicular –most common type
- processus vaginalis obliterated
above testis, remains patent in
proximal part
III. Infantile –processus
vaginalis patent from
vaginal sac to superficial
inguinal ring

IV. Interstitial –diverticulum

of processus extends
between layers of
developing abdominal wall
 Acquired indirect inguinal hernia

- Due to increased abdominal

pressure
- Abdominal contents pushed
through deep inguinal ring
into inguinal canal
 INGUINAL HERNIA

INDIRECT DIRECT

• Through the deep inguinal • Through the ant abd wall

ring
• Lateral to inf epigastric A
• More common in children
and young adults
• Due to patent processes
vaginalis
(Hesselbach’s ∆ )
• Medial to inf epigastric A
• More common in older
adults
• Due to muscular weakness
DIRECT & INDIRECT INGUINAL HERNIAL SITES
Treatment of indirect inguinal hernia
• Herniotomy – amputation of sac at parietal peritoneum after
reduction of contents
• Herniorrhaphy –repair of post wall of canal
• Hernoplasty –herniorrhaphy + mesh repair ( sterile, woven
material made from a synthetic plastic- like material such as
polypropylene)

Treatment of direct inguinal hernia –

• Simple inversion of sac
• Herniorraphy
• hernioplasty