Inguinal Canal and Hernias

Good morning, this is Dr. Adel Bondok, professor of anatomy and neuroscience, Mansoura University, Egypt. Today I am going to talk about the endoenal canal and the endoenal hernia. Actually, the endoenal canal is a canal that is located in the middle of the head. canal is a fibromuscular canal in the lower part of the anterior abdominal wall above the medial half of the inguinal ligament this is the inguinal ligament so i will talk about the location okay location in the lower part of the anterior abdominal wall above the medial half of the inguinal ligament. It is about 4 cm long or 1.5 inches long. It is directed downward and medially. It extends from the deep inguinal ring to the superficial inguinal ring. i will talk about the boundaries the contents the clinical importance which is the oblique inguinal hernia and then the mechanics of the inguinal canal and why hernia formation doesn't occur Let us start by comparing the superficial inguinal ring with the deep inguinal ring. This is the superficial inguinal ring and this is the deep inguinal ring. Start by the location. The superficial inguinal ring is an opening in the external oblique aponeurosis. This is the external oblique aponeurosis above the pubic tubercle. The deep inguinal ring is an opening in the transversus fascia half an inch above the mid-inguinal point and it is located lateral to the inferior. inferior epigastric artery. This is the inferior epigastric artery. The margin of the superficial inguinal ring gives an extension around the spermatic cord called external spermatic fascia. The margin of the deep inguinal ring gives an extension around the spermatic cord called internal spermatic fascia The superficial inguinal ring transmits the spermatic cord in the male or round ligament of the uterus in the female plus the ilio-inguinal nerve. The deep inguinal ring transmits only the spermatic cord or the round ligament of the uterus. now let us talk about the walls of the inguinal canal again it starts from the deep inguinal ring to the superficial inguinal ring and the deep inguinal ring is an opening in the transversal fascia while the superficial inguinal ring is an opening in the external oblique aponeurosis so let us talk about the anterior roll the anterior roll is formed formed of external oblique upon your roses along the whole length of the inguinal canal. and then the flesh fibers of the internal oblique muscle along the lateral half of the inguinal canal. Regarding the posterior wall, transversal fascia along the whole length of the inguinal canal plus the conjoined tendon in the medial third of the posterior wall. Regarding the floor, the floor is the upper surface of the inguinal ligament, and the inguinal ligament is extension of the external oblique upon neurosis. The roof of the inguinal canal, this is the roof, is the arched lower fibers of the internal oblique and the transversus abdominis muscle. Let us remove the roof to open the canal. the canal transmits or contains a spermatic cord in the male around the ligament of the uterus in the female plus the ilio-inguinal nerve this is the spermatic cord coming from the deep ring to the superficial ring regarding the clinical importance of the This is the inguinal canal, beginning from the deep ring to the superficial ring. So the clinical importance, it gives the passage to the oblique inguinal hernia. So the oblique inguinal hernia passes through the deep inguinal ring. Then the inguinal canal, then the superficial inguinal ring to enter the scrotum. So the oblique inguinal hernia or the indirect inguinal hernia enters the scrotum. And the landmark here is the inferior epigastric artery. The neck of the hernia is lateral to the inferior epigastric artery. We have another triangle here, it's called the inguinal triangle. This inguinal triangle is bounded medially by the rectus abdominis muscle, laterally by the inferior epigastric artery, and the base is by the inguinal ligament. This triangle is very important clinically because it gives a passage to the direct inguinal hernia. Direct inguinal hernia. And look at the inferior epigastric artery. The inferior epigastric artery is lateral to the direct hernia. Again, this is the inguinal triangle. This inguinal triangle is bounded medially by the rectus muscle, laterally by the inferior epigastric artery, and the base is the inguinal ligament. ligament and the clinical importance it gives a passage to the direct inguinal hernia and this direct inguinal hernia is medial to the inferior epigastric artery This is the inguinal canal, this is the deep inguinal ring and this is the superficial inguinal ring. Let us compare between the inguinal hernia and the femoral hernia. The inguinal hernia is above the pubic tubercle and the inguinal ligament. The femoral hernia lies below the pubic tubercle and the inguinal ligament. Let us compare between the direct and indirect inguinal hernia or direct and oblique hernia. This is the oblique inguinal hernia. The oblique inguinal hernia passes through the inguinal canal to enter the scrotum. The direct inguinal hernia passes through the inguinal triangle and it doesn't descend into the scrotum. The inferior epigastric artery is medial to the oblique hernia and is lateral to the direct hernia. This is the inferior epigastric artery, this is the oblique inguinal hernia, and this is the direct inguinal hernia. So the oblique inguinal hernia passes through the inguinal canal, the direct inguinal hernia passes through the inguinal triana. The oblique inguinal hernia is lateral to the inferior epigastric artery. The direct inguinal hernia is medial to the inferior epigastric artery. The oblique inguinal hernia descends into the scrotum. The direct inguinal hernia doesn't descend into the scrotum. Now mechanics of the endoenal canal. Why hernia doesn't occur? What are the factors which prevent hernia formation? First, the oblique direction of the canal. the canal is oblique. Second, there is a distance between the direct inguinal ring and the superficial inguinal ring. Distance between the two rings. Number three, The weakest part of the anterior roll, which is the superficial inguinal ring, is supported or reinforced by the strongest part of the posterior roll, which is the conjoined tendon. the conjoined tendon supports the superficial inguinal ring. On the other hand, the weak part of the posterior roll, which is the deep ring, is supported by the strongest part of the anterior roll, the anterior. which is the internal oblique muscle. And the last point is that during contraction of the anterior abdominal wall muscles, the canal is closed by compressing the roof against the floor. So again, what are the five factors which prevent hernia formation? Oblique direction of the canal, distance between the deep ring and superficial ring. The Superficial Ring is supported by by or reinforced by the conjoined tendon, the deep inguinal ring is supported or reinforced by the internal oblique muscle, the canal is closed by compressing the roof against the floor during contraction of the abdominal wall muscles. And thank you very much, best wishes and good luck.

canal is a fibromuscular canal in the lower part of the anterior abdominal wall above the medial half of the inguinal ligament this is the inguinal ligament so i will talk about the location okay location in the lower part of the anterior abdominal wall above the medial half of the inguinal ligament. It is about 4 cm long or 1.5 inches long. It is directed downward and medially.

It extends from the deep inguinal ring to the superficial inguinal ring. i will talk about the boundaries the contents the clinical importance which is the oblique inguinal hernia and then the mechanics of the inguinal canal and why hernia formation doesn't occur Let us start by comparing the superficial inguinal ring with the deep inguinal ring. This is the superficial inguinal ring and this is the deep inguinal ring.

Start by the location. The superficial inguinal ring is an opening in the external oblique aponeurosis. This is the external oblique aponeurosis above the pubic tubercle.

The deep inguinal ring is an opening in the transversus fascia half an inch above the mid-inguinal point and it is located lateral to the inferior. inferior epigastric artery. This is the inferior epigastric artery. The margin of the superficial inguinal ring gives an extension around the spermatic cord called external spermatic fascia.

The margin of the deep inguinal ring gives an extension around the spermatic cord called internal spermatic fascia The superficial inguinal ring transmits the spermatic cord in the male or round ligament of the uterus in the female plus the ilio-inguinal nerve. The deep inguinal ring transmits only the spermatic cord or the round ligament of the uterus. now let us talk about the walls of the inguinal canal again it starts from the deep inguinal ring to the superficial inguinal ring and the deep inguinal ring is an opening in the transversal fascia while the superficial inguinal ring is an opening in the external oblique aponeurosis so let us talk about the anterior roll the anterior roll is formed formed of external oblique upon your roses along the whole length of the inguinal canal. and then the flesh fibers of the internal oblique muscle along the lateral half of the inguinal canal.

Regarding the posterior wall, transversal fascia along the whole length of the inguinal canal plus the conjoined tendon in the medial third of the posterior wall. Regarding the floor, the floor is the upper surface of the inguinal ligament, and the inguinal ligament is extension of the external oblique upon neurosis. The roof of the inguinal canal, this is the roof, is the arched lower fibers of the internal oblique and the transversus abdominis muscle.

Let us remove the roof to open the canal. the canal transmits or contains a spermatic cord in the male around the ligament of the uterus in the female plus the ilio-inguinal nerve this is the spermatic cord coming from the deep ring to the superficial ring regarding the clinical importance of the This is the inguinal canal, beginning from the deep ring to the superficial ring. So the clinical importance, it gives the passage to the oblique inguinal hernia.

So the oblique inguinal hernia passes through the deep inguinal ring. Then the inguinal canal, then the superficial inguinal ring to enter the scrotum. So the oblique inguinal hernia or the indirect inguinal hernia enters the scrotum.

And the landmark here is the inferior epigastric artery. The neck of the hernia is lateral to the inferior epigastric artery. We have another triangle here, it's called the inguinal triangle.

This inguinal triangle is bounded medially by the rectus abdominis muscle, laterally by the inferior epigastric artery, and the base is by the inguinal ligament. This triangle is very important clinically because it gives a passage to the direct inguinal hernia. Direct inguinal hernia. And look at the inferior epigastric artery. The inferior epigastric artery is lateral to the direct hernia.

Again, this is the inguinal triangle. This inguinal triangle is bounded medially by the rectus muscle, laterally by the inferior epigastric artery, and the base is the inguinal ligament. ligament and the clinical importance it gives a passage to the direct inguinal hernia and this direct inguinal hernia is medial to the inferior epigastric artery This is the inguinal canal, this is the deep inguinal ring and this is the superficial inguinal ring.

Let us compare between the inguinal hernia and the femoral hernia. The inguinal hernia is above the pubic tubercle and the inguinal ligament. The femoral hernia lies below the pubic tubercle and the inguinal ligament. Let us compare between the direct and indirect inguinal hernia or direct and oblique hernia.

This is the oblique inguinal hernia. The oblique inguinal hernia passes through the inguinal canal to enter the scrotum. The direct inguinal hernia passes through the inguinal triangle and it doesn't descend into the scrotum.

The inferior epigastric artery is medial to the oblique hernia and is lateral to the direct hernia. This is the inferior epigastric artery, this is the oblique inguinal hernia, and this is the direct inguinal hernia. So the oblique inguinal hernia passes through the inguinal canal, the direct inguinal hernia passes through the inguinal triana.

The oblique inguinal hernia is lateral to the inferior epigastric artery. The direct inguinal hernia is medial to the inferior epigastric artery. The oblique inguinal hernia descends into the scrotum. The direct inguinal hernia doesn't descend into the scrotum.

Now mechanics of the endoenal canal. Why hernia doesn't occur? What are the factors which prevent hernia formation?

First, the oblique direction of the canal. the canal is oblique. Second, there is a distance between the direct inguinal ring and the superficial inguinal ring. Distance between the two rings.

Number three, The weakest part of the anterior roll, which is the superficial inguinal ring, is supported or reinforced by the strongest part of the posterior roll, which is the conjoined tendon. the conjoined tendon supports the superficial inguinal ring. On the other hand, the weak part of the posterior roll, which is the deep ring, is supported by the strongest part of the anterior roll, the anterior.

which is the internal oblique muscle. And the last point is that during contraction of the anterior abdominal wall muscles, the canal is closed by compressing the roof against the floor. So again, what are the five factors which prevent hernia formation? Oblique direction of the canal, distance between the deep ring and superficial ring.

The Superficial Ring is supported by by or reinforced by the conjoined tendon, the deep inguinal ring is supported or reinforced by the internal oblique muscle, the canal is closed by compressing the roof against the floor during contraction of the abdominal wall muscles. And thank you very much, best wishes and good luck.

Transcript for:Inguinal Canal and Hernias

Transcript for:
Inguinal Canal and Hernias