INGUINAL CANALINGUINAL CANALINGUINAL HERNIA &INGUINAL HERNIA &

MALE EXTERNAL GENITALIAMALE EXTERNAL GENITALIA

Dr. Mujahid KhanDr. Mujahid Khan

Inguinal CanalInguinal Canal

It is an oblique passage through the lower part of the It is an oblique passage through the lower part of the anterior abdominal wallanterior abdominal wall

Present in both sexesPresent in both sexes

It allows structures to pass to and from the testis to the It allows structures to pass to and from the testis to the abdomen in malesabdomen in males

In females it permits the passage of the round ligament In females it permits the passage of the round ligament of the uterus from the uterus to the labium majusof the uterus from the uterus to the labium majus

Transmits ilioinguinal nerve in both sexesTransmits ilioinguinal nerve in both sexes

Inguinal CanalInguinal Canal

It is about 1 ½ inches or 4cm long in the adultsIt is about 1 ½ inches or 4cm long in the adults

Extends from the deep inguinal ring downward Extends from the deep inguinal ring downward and medially to the superficial inguinal ringand medially to the superficial inguinal ring

Lies parallel to and immediately above the Lies parallel to and immediately above the inguinal ligamentinguinal ligament

In the newborn child, the deep ring lies almost In the newborn child, the deep ring lies almost directly posterior to the superficial ring directly posterior to the superficial ring

Deep Inguinal RingDeep Inguinal Ring

Is an oval opening in the fascia Is an oval opening in the fascia transversalistransversalis

Lies about ½ inch (1.3cm) above the Lies about ½ inch (1.3cm) above the inguinal ligament midway between the inguinal ligament midway between the anterosuperior iliac spine and the anterosuperior iliac spine and the symphysis pubissymphysis pubis

Margins of the ring give attachment to the Margins of the ring give attachment to the internal spermatic fasciainternal spermatic fascia

Superficial Inguinal RingSuperficial Inguinal Ring

Is triangular in shapeIs triangular in shape

Lies in the aponeurosis of the external Lies in the aponeurosis of the external oblique muscleoblique muscle

Lies immediately above and medial to the Lies immediately above and medial to the pubic tuberclepubic tubercle

Its margins give attachment to the external Its margins give attachment to the external spermatic fascia spermatic fascia

Anterior Wall of Inguinal CanalAnterior Wall of Inguinal Canal Is formed along its entire length by Is formed along its entire length by

aponeurosis of the external oblique aponeurosis of the external oblique musclemuscle

It is reinforced in its lateral third by the It is reinforced in its lateral third by the origin of the internal oblique from the origin of the internal oblique from the inguinal ligamentinguinal ligament

This wall is strongest where it lies opposite This wall is strongest where it lies opposite the weakest part of posterior wall, that is the weakest part of posterior wall, that is deep inguinal ringdeep inguinal ring

Posterior Wall of Inguinal CanalPosterior Wall of Inguinal Canal

Is formed along its entire length by the fascia Is formed along its entire length by the fascia transversalistransversalis

It is reinforced in its medial third by conjoint It is reinforced in its medial third by conjoint tendon, the common tendon of insertion of tendon, the common tendon of insertion of internal oblique and transversus, attached to the internal oblique and transversus, attached to the pubic crest and pectineal linepubic crest and pectineal line

This wall is strongest where it lies opposite the This wall is strongest where it lies opposite the weakest part of the anterior wall, that is weakest part of the anterior wall, that is superficial inguinal ringsuperficial inguinal ring

Inferior Wall of Inguinal CanalInferior Wall of Inguinal Canal

Is formed by the rolled-under inferior edge Is formed by the rolled-under inferior edge of the aponeurosis of the external oblique of the aponeurosis of the external oblique muscle called inguinal ligament and at its muscle called inguinal ligament and at its medial end, the lacunar ligamentmedial end, the lacunar ligament

Superior Wall of Inguinal CanalSuperior Wall of Inguinal Canal

Is formed by the arching lowest fibers of Is formed by the arching lowest fibers of the internal oblique and transversus the internal oblique and transversus abdominis musclesabdominis muscles

Functions of Inguinal CanalFunctions of Inguinal Canal

It allows structures of spermatic cord to It allows structures of spermatic cord to pass to and from the testis to the abdomen pass to and from the testis to the abdomen in malein male

Permits the passage of round ligament of Permits the passage of round ligament of uterus from the uterus to the labium majus uterus from the uterus to the labium majus in femalein female

Mechanics of Inguinal CanalMechanics of Inguinal Canal

The presence of inguinal canal in the The presence of inguinal canal in the lower part of the anterior abdominal wall in lower part of the anterior abdominal wall in both sexes constitutes a potential both sexes constitutes a potential weaknessweakness

Except in the newborn infant, the canal is Except in the newborn infant, the canal is an oblique passage with the weakest an oblique passage with the weakest areas, that are superficial and deep areas, that are superficial and deep inguinal rings inguinal rings

Mechanics of Inguinal CanalMechanics of Inguinal Canal

When great straining efforts may be necessary, When great straining efforts may be necessary, as in defecation and parturition, the person as in defecation and parturition, the person naturally tends to assume the squatting position naturally tends to assume the squatting position

The hip joints are flexed and the anterior The hip joints are flexed and the anterior surfaces of the thighs are brought up against the surfaces of the thighs are brought up against the anterior abdominal wallanterior abdominal wall

By this means the lower part of the anterior By this means the lower part of the anterior abdominal wall is protected by the thighsabdominal wall is protected by the thighs

Spermatic CordSpermatic Cord It is a collection of structures that pass It is a collection of structures that pass

through the inguinal canal to and from the through the inguinal canal to and from the testistestis

It is covered with three concentric layers of It is covered with three concentric layers of fascia derived from the layers of anterior fascia derived from the layers of anterior abdominal wallabdominal wall

It begins at the deep inguinal ring lateral to It begins at the deep inguinal ring lateral to the inferior epigastric artery and ends at the inferior epigastric artery and ends at the testis the testis

Structures of Spermatic CordStructures of Spermatic Cord

Vas deferensVas deferens Testicular artery and veinTesticular artery and vein Testicular lymph vesselsTesticular lymph vessels Autonomic nervesAutonomic nerves Processus vaginalisProcessus vaginalis Cremastric arteryCremastric artery Artery of the vas deferenceArtery of the vas deference Genital branch of genitofemoral nerveGenital branch of genitofemoral nerve

Vas DeferensVas Deferens

It is a cord like structure It is a cord like structure

Can be palpated between finger and Can be palpated between finger and thumb in the upper part of the scrotumthumb in the upper part of the scrotum

It is a thick walled muscular duct that It is a thick walled muscular duct that transport spermatozoa from the epididymis transport spermatozoa from the epididymis to the urethrato the urethra

Testicular ArteryTesticular Artery

It is a branch of abdominal aortaIt is a branch of abdominal aorta

It is long and slender It is long and slender

Descends on the posterior abdominal wallDescends on the posterior abdominal wall

It traverses the inguinal canal and supplies It traverses the inguinal canal and supplies the testis and the epididymis the testis and the epididymis

Testicular VeinsTesticular Veins

These are the extensive venous plexus, the These are the extensive venous plexus, the pampiniform plexuspampiniform plexus

Leaves the posterior border of the testisLeaves the posterior border of the testis

As the plexus ascends, it becomes reduced in As the plexus ascends, it becomes reduced in size so that at about the level of deep inguinal size so that at about the level of deep inguinal ring, a single testicular vein is formedring, a single testicular vein is formed

Drains into left renal vein on left side and inferior Drains into left renal vein on left side and inferior vena cava on right sidevena cava on right side

Covering of the Spermatic CordCovering of the Spermatic Cord

The covering of the spermatic cord are The covering of the spermatic cord are three concentric layers of fascia derived three concentric layers of fascia derived from the layers of the anterior abdominal from the layers of the anterior abdominal wall wall

Each covering is acquired as the Each covering is acquired as the processus vaginalis descends into the processus vaginalis descends into the scrotum through the layers of the scrotum through the layers of the abdominal wallabdominal wall

Covering of the Spermatic CordCovering of the Spermatic Cord

External Spermatic fascia: Is derived from the External Spermatic fascia: Is derived from the external oblique aponeurosis and attached to external oblique aponeurosis and attached to the margins of the superficial inguinal ringthe margins of the superficial inguinal ring

Cremasteric Fascia: Is derived from the internal Cremasteric Fascia: Is derived from the internal oblique muscleoblique muscle

Internal Spermatic Fascia: Is derived from the Internal Spermatic Fascia: Is derived from the fascia transversalis and attached to the margins fascia transversalis and attached to the margins of deep inguinal ring of deep inguinal ring

Inguinal HerniaInguinal Hernia

A hernia is the protrusion of part of the A hernia is the protrusion of part of the abdominal contents beyond the normal abdominal contents beyond the normal confines of the abdominal wallconfines of the abdominal wall

Consists of three parts: the sac, contents Consists of three parts: the sac, contents of the sac, covering of the sacof the sac, covering of the sac

Hernial coverings are formed from the Hernial coverings are formed from the layers of the abdominal wall through which layers of the abdominal wall through which the hernial sac passesthe hernial sac passes

Indirect Inguinal HerniaIndirect Inguinal Hernia It is the most common form of herniaIt is the most common form of hernia

Is believed to be congenital in originIs believed to be congenital in origin

The hernial sac is remains of processus The hernial sac is remains of processus vaginalisvaginalis

Enters the inguinal canal through the deep Enters the inguinal canal through the deep inguinal ring lateral to the inferior epigastric inguinal ring lateral to the inferior epigastric vesselsvessels

It may extend part of the way along the canal or It may extend part of the way along the canal or as far as the superficial inguinal ring as far as the superficial inguinal ring

Indirect Inguinal HerniaIndirect Inguinal Hernia If the processus vaginalis has undergone no If the processus vaginalis has undergone no

obliteration, the hernia is complete and extends obliteration, the hernia is complete and extends through the superficial inguinal ring down into through the superficial inguinal ring down into the scrotum or labium majusthe scrotum or labium majus

Under these circumstances the neck of the Under these circumstances the neck of the hernial sac lies at the deep inguinal ring hernial sac lies at the deep inguinal ring

It is 20 times more common in young males than It is 20 times more common in young males than femalesfemales

Is more common on the right sideIs more common on the right side

Direct Inguinal HerniaDirect Inguinal Hernia

It composes about 15% of all inguinal herniasIt composes about 15% of all inguinal hernias

Common in old men with weak abdominal Common in old men with weak abdominal muscles and rare in women muscles and rare in women

Hernial sac bulges forward through the posterior Hernial sac bulges forward through the posterior wall of the inguinal canal medial to the inferior wall of the inguinal canal medial to the inferior epigastric arteryepigastric artery

The neck of the hernial sac is wideThe neck of the hernial sac is wide

ScrotumScrotum

Is an outpouching of the lower part of the Is an outpouching of the lower part of the anterior abdominal wallanterior abdominal wall

It contains testes, epididymis, and the lower It contains testes, epididymis, and the lower ends of the spermatic cordends of the spermatic cord

Its wall has following layers: skin, superficial Its wall has following layers: skin, superficial fascia, external spermatic fascia derived from fascia, external spermatic fascia derived from external oblique, cremastric fascia derived from external oblique, cremastric fascia derived from internal oblique internal spermatic fascia derived internal oblique internal spermatic fascia derived from transversalis, and tunica vaginalisfrom transversalis, and tunica vaginalis

Skin of the ScrotumSkin of the Scrotum

Skin of the scrotum is thin, wrinkled, and Skin of the scrotum is thin, wrinkled, and pigmented and forms a single pouchpigmented and forms a single pouch

A ridge in the midline indicates the line of A ridge in the midline indicates the line of fusion of the two lateral labioscrotal fusion of the two lateral labioscrotal swellingsswellings

Superficial fascia is continuous with the Superficial fascia is continuous with the fatty and membranous layers of the fatty and membranous layers of the anterior abdominal wallanterior abdominal wall

Superficial FasciaSuperficial Fascia Superficial fascia is continuous with the fatty and Superficial fascia is continuous with the fatty and

membranous layers of the anterior abdominal wallmembranous layers of the anterior abdominal wall

The fat is replaced by smooth muscle called dartos The fat is replaced by smooth muscle called dartos musclemuscle

Is responsible for wrinkles of the skinIs responsible for wrinkles of the skin

Innervated by sympathetic nerve fibersInnervated by sympathetic nerve fibers

Both layers of sup. Fascia contribute to a median Both layers of sup. Fascia contribute to a median partition that crosses the scrotum and separates the partition that crosses the scrotum and separates the testes from each othertestes from each other

Spermatic FasciaeSpermatic Fasciae Lie beneath the superficial fasciaLie beneath the superficial fascia

Derived from three layers of anterior abdominal Derived from three layers of anterior abdominal wall on each sidewall on each side

The external spermatic fascia is derived from The external spermatic fascia is derived from external obliqueexternal oblique

The cremastric fascia is derived from internal The cremastric fascia is derived from internal obliqueoblique

The internal spermatic fascia is derived from the The internal spermatic fascia is derived from the fascia transversalisfascia transversalis

Cremasteric reflexCremasteric reflex

The cremasteric muscle can be made to The cremasteric muscle can be made to contract by stroking the skin on the medial contract by stroking the skin on the medial aspect of the thigh, called cremasteric aspect of the thigh, called cremasteric reflexreflex

The function of cremaster muscle is to The function of cremaster muscle is to raise the testis and the scrotum upward for raise the testis and the scrotum upward for warmth and protection against injurywarmth and protection against injury

Tunica VaginalisTunica Vaginalis

Lies within the spermatic fasciaeLies within the spermatic fasciae

Covers the anterior, medial and lateral surfaces Covers the anterior, medial and lateral surfaces of each testisof each testis

It is the lower expanded part of the processus It is the lower expanded part of the processus vaginalisvaginalis

Normally shut off just before birth from the upper Normally shut off just before birth from the upper part of the processus and the peritoneal cavitypart of the processus and the peritoneal cavity

TestisTestis

Is a firm, mobile organ, within the scrotumIs a firm, mobile organ, within the scrotum

Left testis usually lies at a lower level than the Left testis usually lies at a lower level than the rightright

Upper end of the gland is tilted forwardUpper end of the gland is tilted forward

Surrounded by a tough fibrous capsule, the Surrounded by a tough fibrous capsule, the tunica albugineatunica albuginea

A series of fibrous septa divide the interior of the A series of fibrous septa divide the interior of the organ into lobulesorgan into lobules

TestisTestis

Lying in each lobule are one to three Lying in each lobule are one to three coiled seminiferous tubulescoiled seminiferous tubules

The tubules open into the network of The tubules open into the network of channels called the rete testischannels called the rete testis

Small efferent ductules connect the rete Small efferent ductules connect the rete testis to the upper end of the epididymistestis to the upper end of the epididymis

EpididymisEpididymis

Is a firm structure lying posterior to the testis, Is a firm structure lying posterior to the testis, with the vas deferens lying on its medial side with the vas deferens lying on its medial side

Has an expanded upper end, the head, a body, Has an expanded upper end, the head, a body, and a pointed tail inferiorlyand a pointed tail inferiorly

Lateral groove between it and testis called sinus Lateral groove between it and testis called sinus of epididymisof epididymis

Is a much coiled tube nearly 20 feet longIs a much coiled tube nearly 20 feet long

EpididymisEpididymis

The tube emerges from the tail of the epididymis The tube emerges from the tail of the epididymis as a vas deferens, that enters the spermatic as a vas deferens, that enters the spermatic cordcord

The long length of the duct of epididymis The long length of the duct of epididymis provides storage space for the spermatozoa and provides storage space for the spermatozoa and allows them to matureallows them to mature

Its main function is absorption of fluidIts main function is absorption of fluid

May add some substances to the seminal fluid to May add some substances to the seminal fluid to nourish the maturing spermnourish the maturing sperm