The inguinal canal (canalis inguinalis) is paired, represents an oblique slit 4-5 cm long, located in the regio inguinalis dextra et sinistra above the inguinal ligament.
In men, the inguinal canal and its rings are wider, since a more massive spermatic cord passes through it (Fig. 171), in women - the round ligament of the uterus. In men, the inguinal canal is wider also because at the ninth month of intrauterine development, the testicle descends through the inguinal canal from the abdominal cavity into the scrotum. Therefore, congenital inguinal hernias are more common in boys than in girls.
The inguinal canal has four walls and two openings (Fig. 172).
171. Superficial ring of the male inguinal canal and external opening of the femoral canal.
1 - linea alba; 2 - m. obliquus abdominis externus; 3 - crus mediale; 4 - lig. reflexum; 5 - crus laterale; 6 - funiculus spermaticus; 7 - m. cremaster; 8 - v. saphena magna; 9 - cornu inferius (margo falciformis); 10 - v. femoralis; 11 - margo falciformis (cornu superius).
172. Superficial (A) and deep (B) inguinal rings (diagram).
1 - fibrae intercrurales; 2 - lig. reflexum; 3 - lig. lacunare; 4 - crus mediale; 5 - crus laterale; 6 - symphysis ossis pubis; 7 - r. superior ossis pubis; 8 - m. rectus abdominis; 9 - lig. interfoveolare; 10 - lig. inguinal; 11 - ductus defferens.
The lower wall of the inguinal canal is formed by the inguinal ligament, which represents the tucked edge of the aponeurosis of the external oblique abdominal muscle, connecting to the transverse abdominal fascia.
The anterior wall is limited by the aponeurosis of the external oblique abdominal muscle, sometimes representing not a compact, but a reticular plate.
The upper wall is represented by the lower edges of the internal oblique muscle and the transverse abdominal muscle. In men, a small muscle bundle separates from the lower edge of the internal oblique muscle, forming a muscle - the levator testis (m. cremaster), which exits the inguinal canal through the external opening and reaches the testicle.
The posterior wall is formed by the transverse fascia of the abdomen. It fuses with the posterior edge of the inguinal ligament.
The superficial inguinal ring (anulus inguinalis superficialis) is located above the inguinal ligament and is limited by the divergence of the tendon (aponeurosis) of the external oblique abdominal muscle into two legs: medial (crus mediale) and lateral (crus laterale). The medial crus is attached to the symphysis; in this case, the left one is located anterior to the right, and the lateral one grows to the pubic tubercle. Consequently, the further the tuberculum pubicum is from the symphysis, the wider the opening of the inguinal canal will be. Based on this feature, it is possible to some extent establish a predisposition to the occurrence of inguinal hernias, which is easily determined radiographically. The gap on the lateral side is strengthened by interpeduncular connective tissue fibers (fibrae intercrurales), separated from the tendon of the external oblique abdominal muscle. The hole should normally allow the tip of the little finger to pass through.
The deep inguinal ring (anulus inguinalis profundus) is located 1-1.5 cm above the middle of the inguinal ligament. It does not exist in the form of a free hole, since it contains the invaginated transverse fascia of the abdomen, which surrounds the spermatic cord or round ligament of the uterus. The deep inguinal ring corresponds to the lateral inguinal fossa (fossa inguinalis lateralis), limited on the medial side by a. et v. epigastricae inferiores; a bundle of fibers split off from the lower edge of the transverse muscle is connected to them, forming m. interfoveolaris (Fig. 173).
173. Inner surface of the anterior wall of the abdomen and pelvis.
1 - lig. umbilicale medianum; 2 - lig. umbilicale laterale; 3 - vagina m. recti abdominis; 4 - m. rectus abdominis; 5 - anulus inguinalis profundus; 6 - lig. interfoveolare; 7 - ductus defferens; 8 - ureter; 9 - vesica urinaria; 10 - vesica seminalis; 11 - fossa supravesicalis; 12 - fossa inguinalis medialis; 13 - fossa inguinalis lateralis; 14 - plica umbilicalis lateralis; 15 - plica umbilicalis mediana.
The inguinal canal is located in the lower part of the groin region - in the inguinal triangle, the sides of which are:
1. at the top– a horizontal line drawn from the border of the outer and middle third of the inguinal ligament;
2. medially– outer edge of the rectus abdominis muscle;
3. below- inguinal ligament.
In the inguinal canal there are two openings, or rings, and four walls.
Openings of the inguinal canal:
1. superficial inguinal ring formed by diverging medial and lateral legs of the aponeurosis of the external oblique abdominal muscle, fastened by interpeduncular fibers, rounding the gap between the legs into a ring;
2. deep inguinal ring formed by the transverse fascia and represents its funnel-shaped retraction during the transition from the anterior abdominal wall to the elements of the spermatic cord (round ligament of the uterus); It corresponds to the lateral inguinal fossa on the side of the abdominal cavity.
Walls of the inguinal canal:
1. front– aponeurosis of the external oblique abdominal muscle;
2. back– transverse fascia;
3. top– overhanging edges of the internal oblique and transverse muscles;
4. bottom- inguinal ligament.
The space between the upper and lower walls of the inguinal canal is called the inguinal gap.
Contents of the inguinal canal:
1. spermatic cord (in men) or round ligament of the uterus (in women);
2. ilioinguinal nerve;
3. genital branch of the genital femoral nerve.
Femoral canal
The femoral canal is formed during the formation of a femoral hernia (when the hernial sac emerges from the abdominal cavity in the area of the femoral fossa, between the superficial and deep layers of its own fascia and exits under the skin of the thigh through the oval fossa).
Femoral canal openings:
1. inner hole corresponds to the femoral ring, which is limited by:
* in front – inguinal ligament;
* posteriorly – pectineal ligament;
* medially – lacunar ligament;
* laterally – femoral vein;
2.outer hole– subcutaneous fissure (this name is given to the oval fossa after a rupture of the ethmoid fascia).
Walls of the femoral canal:
1. front– superficial layer of the proper fascia of the thigh (in this place it is called the superior horn of the falciform edge);
2. back– a deep layer of the thigh’s own fascia (in this place it is called the pectineal fascia);
3. lateral– sheath of the femoral vein.
Features of the anterolateral abdominal wall in newborns and children
In infants, the abdomen has the shape of a cone, with the narrow part facing downwards. The anterior abdominal wall in infancy protrudes forward and sags somewhat, which is associated with insufficient development of muscles and aponeuroses. Later, when the child begins to walk, with increased muscle tone, the bulge gradually disappears.
The skin of the abdomen in children is tender, there is relatively a lot of subcutaneous fat, especially in the suprapubic and inguinal region, where its thickness can reach 1.0–1.5 cm. The superficial fascia is very thin and has one layer even in overweight and physically developed children. The muscles of the abdominal wall in children under one year of age are poorly developed, the aponeuroses are delicate and relatively wide. As the child grows, muscle differentiation occurs, and the aponeurotic part gradually decreases and thickens. Between the Spigelian line and the lateral edge of the rectus abdominis muscles, from the costal arch to the Pupart ligament, aponeurotic stripes 0.5-2.5 cm wide stretch on both sides. These areas of the abdominal wall are the weakest in young children and can serve as sites for the formation of hernial protrusions ( Spigelian line hernia). The sheath of the rectus abdominis muscle is poorly developed, especially its posterior wall.
The linea alba in infants is relatively wide and thin. Down from the umbilical ring it gradually narrows and turns into a very narrow strip. In its upper part, near the navel, thinned areas are often observed, in which defects in the form of elongated narrow cracks are found between the aponeurotic fibers. Neurovascular bundles pass through some of them. They are often the gateway to hernias of the white line of the abdomen. The transverse fascia and parietal peritoneum in young children are in close contact with each other, since the preperitoneal fatty tissue is not expressed. It begins to form after two years of life, and its amount increases with age, especially sharply during puberty.
The inner surface of the anterior abdominal wall in young children looks smoother than in adults. The supravesical fossa is almost absent. In the lateral umbilical-vesical folds, the umbilical arteries remain patent for some time after birth. The blood vessels located in the layers of the anterior abdominal wall in young children are very elastic, easily collapse and bleed little when cut.
After the umbilical cord falls off (5–7 days after birth), in its place, as a result of fusion of the skin with the edge of the umbilical ring and the parietal layer of the peritoneum, a “navel” is formed, which is a retracted connective tissue scar. Simultaneously with the formation of the navel, the umbilical ring closes. The densest is its lower semicircle, where three connective tissue cords end, corresponding to the obliterated umbilical arteries and the urinary duct. During the first weeks of the child’s life, the latter, together with the Warton’s jelly covering them, turn into dense scar tissue and, merging with the lower edge of the umbilical ring, provide its tensile strength. The upper half of the ring is weaker and can serve as a place for hernias to emerge, since a thin-walled membrane passes here umbilical vein, covered only by a thin layer of connective tissue and umbilical fascia. The umbilical fascia in newborns sometimes does not reach the upper edge of the umbilical ring, creating an anatomical prerequisite for the formation of a hernial orifice. In one-year-old children, the fascia completely or partially covers the umbilical region.
In young children, the inguinal canal is short and wide, and the direction is almost straight - from front to back. As the child grows, as the distance between the wings of the ilium increases, the course of the canal becomes oblique and its length increases. The inguinal canal in newborns and often in children of the first year of life is lined from the inside with the serous membrane of the ungrown vaginal process of the peritoneum.
The inguinal canal (canalis inguinalis) is located above the inguinal ligament and is a slit-like space between it and the broad abdominal muscles. In the inguinal canal there are 4 walls: anterior, upper, lower and posterior and 2 openings: internal and external (Fig. 6).
Rice. 6. Inguinal canal: 1 - anterior wall of the inguinal canal (aponeurosis of the external oblique abdominal muscle); 2 - upper wall of the inguinal canal (lower edges of the internal oblique and transverse abdominal muscles; 3 - posterior wall of the inguinal canal (transverse fascia); 4 - lower wall of the inguinal canal (inguinal ligament); 5 - aponeurosis of the external oblique abdominal muscle; 6 - inguinal ligament ; 7 - internal oblique muscle of the abdomen; 8 - transversus abdominis muscle; 9 - transverse fascia; 10 - ilioinguinal nerve; 11 - genital branch of the genital femoral nerve; 12 - spermatic cord; 13 - levator testis muscle; 14 - vas deferens duct; 15 - external spermatic fascia
Anterior wall of the inguinal canal is the aponeurosis of the external oblique abdominal muscle, which in its lower part thickens and turns posteriorly, forming the inguinal ligament. The latter is the lower wall of the inguinal canal. In this area, the edges of the internal oblique and transverse muscles are located slightly above the inguinal ligament, and thus the upper wall of the inguinal canal is formed. Back wall represented by the transverse fascia.
outer hole, or superficial inguinal ring (annulus inguinalis superficialis), formed by two legs of the aponeurosis of the external oblique abdominal muscle, which diverge to the sides and attach to the pubic symphysis and pubic tubercle. In this case, the legs are strengthened on the outside by the so-called interpeduncular ligament, and on the inside by the curved ligament.
Inner hole, or deep inguinal ring (annulus inguinalis profundus), is a defect in the transverse fascia located at the level of the lateral inguinal fossa.
The contents of the inguinal canal in men are the ilioinguinal nerve, the genital branch of the femorogenital nerve and the spermatic cord. The latter is a set of anatomical formations connected by loose fiber and covered with the tunica vaginalis and the levator testis muscle. In the spermatic cord at the back there is the vas deferens with a. cremasterica and veins, in front of them lie the testicular artery and the pampiniform venous plexus.
The contents of the inguinal canal in women are the ilioinguinal nerve, the genital branch of the genital femoral nerve, the processus vaginalis of the peritoneum and the round ligament of the uterus.
It should be borne in mind that the inguinal canal is the site of two types of hernias: direct and oblique. In the event that the course of the hernial canal corresponds to the location of the inguinal canal, i.e. the mouth of the hernial sac is located in the lateral fossa, the hernia is called oblique. If the hernia comes out in the area of the medial fossa, then it is called direct. The formation of congenital hernias of the inguinal canal is also possible.
The inguinal canal is located in the abdominal wall in the groin area. It is an oblique gap. He has:
- the upper wall, which is limited by the edges of the transverse and oblique abdominal muscles;
- the lower wall, protected by the inguinal ligament;
- back and front walls.
Description of the inguinal canal
The inguinal canal has rings that are wider in men than in women. This is due to the fact that the spermatic cord occupies a larger volume than the uterine ligament. In addition, in the strong half of the population the testicle descends through this organ, so the structure of the inguinal canal is slightly different. Because of this, congenital hernia in this area is more common in men.
The upper wall is separated by the oblique and transverse abdominis muscles, but in men there is still a small muscle bundle with which the testicles can rise. This muscle reaches them through the inguinal canal.
The posterior wall is separated by the transversus abdominis fascia, which passes into the inguinal ligament. The inguinal canal also contains a ring on the surface. It is located above the ligament; the tendons that limit it diverge here. They are divided into the following legs:
- medial, which is attached to the symphysis;
- lateral, grows into the pubic tubercle.
The inguinal canal is vulnerable to hernia, as it is considered a weak area, which can cause organs to protrude.
Weak spots that are located on the abdominal wall
There are such weak spots on the abdominal wall:
- The inguinal canal, as well as its pits. Inguinal hernias appear from these pits.
- The supravesical fossa, which is located between the folds of the peritoneum near the navel (left and right), which are located above the bladder. Here, in addition to inguinal hernias, sliding hernias can be observed.
- Inner femoral ring. In this case, femoral hernias appear in the inguinal ligament and fold.
- Obturator canal.
- Umbilical ring. This is where umbilical hernias appear.
- White line, in which aponeurosis defects appear.
Deep and superficial inguinal ring
The walls of the inguinal canal have a deep inguinal ring. If we consider it from the abdominal cavity, it is a depression in the middle of the inguinal ligament. It is located opposite the inguinal fossa.
But the superficial ring is located above the pubic bone, limited to the legs of the oblique abdominal muscle, which is located outside. There is a medial edge at the top and a lateral edge at the bottom.
Disorders that are observed in the inguinal canal
The anatomy of the inguinal canal is such that this part of the body is not immune from disorders. Some organs may begin to emerge through this canal, and this phenomenon is called an inguinal hernia. We must not forget that both women and men have important organs here, such as the uterine ligament and the spermatic cord, respectively.
The inguinal canal is protected on all sides by muscles. Sometimes pressure may begin to increase in the abdominal part, the internal organs press on each other, begin to be pushed aside, after which they find a weak spot and begin to come out.
Manifestation of hernia
When an inguinal hernia occurs, the groin area begins to protrude. This can be visible at rest, as well as under certain loads. For example:
- lifting heavy things;
- when prostate adenoma appears;
- constipation;
- coughing.
In addition to visual changes, an inguinal hernia causes dull pain in the groin area. It can appear constantly, or it can periodically bother a person.
Examination of the inguinal canal by a doctor
To examine the inguinal canal, no special procedures are required. The doctor examines the patient, then finds out his exact complaints, after which he can establish a diagnosis and identify the presence of abnormalities. In some cases, the presence of a hernia is visually visible.
In order to draw a conclusion about a person’s health status, the doctor examines the inguinal canal. The scheme is as follows: he inserts his little finger into the outer ring. If this organ is in order, only the tip of the finger can go there. When the little finger is inside the ring, the doctor can perform a cough test. This allows him to feel the shocks.
Sometimes, in order to study the inguinal hernia in more detail, the patient will need to undergo an ultrasound. Mostly they do without it. This study is used only in complicated cases.
Operations on the inguinal canal
Surgery is performed in the inguinal canal when other methods have failed to get rid of the hernia. This procedure is performed under local anesthesia. But sometimes general anesthesia is also used when the patient is a child or a mentally disturbed person.
Operation stages:
- First, the doctor makes an incision that runs parallel to the inguinal ligament.
- Subsequently, he receives an exposed inguinal canal, after which a search for the hernia occurs, since there are situations when this is not so easy to do. In this case, the doctor may need the patient to strain. It is for this reason that the operation is performed only under local anesthesia.
- When the doctor has found the target, he dissects it.
- Afterwards, the specialist assesses the general condition of all internal organs.
- If after examination the doctor does not see any abnormalities, then all the organs that came out are immersed in the abdomen.
- Then the hernia sac is ligated and cut off.
- After this, the doctor is faced with the task of performing inguinal canal plastic surgery. There are many methods, but they are very similar to each other. Basically, the muscles and fascia are sutured. Sometimes a specialist can stitch a special mesh to the inguinal canal, which does not harm the organs.
- The last stage of the operation is the final suture.
So, the inguinal canal is a simple organ, but any violations can lead to the appearance of a hernia. The main thing is to start timely treatment in case of such a problem.
Inguinal canal called the gap between the broad abdominal muscles above the medial half of the inguinal ligament. Let us recall that the term “inguinal ligament”, adopted in surgery, implies two ligamentous formations: the true inguinal ligament and the iliopubic tract running parallel, but deeper (posteriorly). Both of these formations are closely adjacent to each other, but there is a very narrow gap between them.
Inguinal canal has an oblique direction: from top to bottom, from outside to inside and from back to front. Its length in men is 4-5 cm; in women it is slightly longer, but compared to men’s it is narrower.
Walls of the inguinal canal
In the inguinal canal There are 4 walls and 2 rings.
Anterior wall of the inguinal canal formed by the aponeurosis of the external oblique abdominal muscle.
Posterior wall of the inguinal canal formed by the transverse fascia. In the medial part it is strengthened by the inguinal sickle, falx inguinalis ( ligament of Henle), connected by the aponeuroses of the internal oblique and transverse abdominal muscles.
At the lateral edge of the rectus abdominis muscle, the falx curves downwards in an arcuate manner and attaches to the pubic tubercle, connecting to the iliopubic tract.
In the area between the medial and lateral inguinal fossae, the transverse fascia (posterior wall of the canal) is strengthened by the interfossa ligament, lig. interfoveolare.
Part back wall inguinal canal medially from a. et v. epigastricae inferiores are called Hesselbach triangle .
Its boundaries are below - inguinal ligament(iliopubic tract), laterally - the lower epigastric vessels, medially - the outer edge of the rectus abdominis muscle. Direct inguinal hernias emerge through this triangle.
Thus, posterior wall of the inguinal canal indeed consists of transversalis fascia, but it is not such a thin plate as it appears on other parts of the abdominal wall. It is compacted and strengthened by tendon elements, although the main role in its strengthening is played by the lower edge of the internal oblique abdominal muscle.
Upper wall of the inguinal canal formed by the lower free edges of the internal oblique and transverse abdominal muscles. The lower edge of the internal oblique muscle of the abdomen, as a rule, is located slightly below the transverse muscle. As already mentioned, the height of the inguinal space and, accordingly, the height of the posterior wall of the inguinal canal depend on this.
The lower wall of the inguinal canal are the inguinal ligament and the iliopubic tract.
Superficial inguinal ring
Superficial inguinal ring, anulus inguinalis superficialis, is formed by two diverging legs of the aponeurosis of the external oblique muscle of the abdomen, the medial of which is attached near the symphysis, and the outer one - to the pubic tubercle. The outer part of the ring is reinforced by arched interpeduncular fibers, fibrae intercrurales.
Sometimes a third, posterior leg is also observed - it makes up recurved ligament, lig. reflexum, which passes into the fibers of the external oblique muscle of the opposite side. The superficial ring has the appearance of an irregular oval, its longitudinal size is 2-3 cm, transverse - 1-2 cm. When externally examined through the skin, the superficial ring normally passes the end of the little finger. Women's sizes surface ring half as much.