Inguinal canal: Anatomy & Clinical Significances

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Inguinal canal

Boundary:

  • Anterior wall:
    • Entire extent: External oblique
    • Lateral part: Reinforced by – Internal oblique
  • Posterior wall:
    • Entire extent: Fascia transversalis
    • Medial part: Conjoint tendon (IO + TA).

  • Roof: Conjoint tendon (IO + TA)
  • Floor: External oblique + Inguinal ligament.

Boundary of Hesselbach’s triangle:

  • Medially: Rectus abdominis
  • Laterally: Inferior epigastric vessels
  • Inferiorly: Inguinal ligament.

Types of hernia:

  • Indirect: Through the deep inguinal ring (MC)
  • Direct: Through the posterior wall of inguinal canal
    • Hesselbach’s triangle can be divided into medial and lateral halves by medial umbilical ligament (obliterated umbilical artery):
      1. If hernia passes through medial half: Medial direct hernia
      2. If hernia passes through lateral half: Lateral direct hernia.

 

Danger zones in laparoscopic hernia surgery

Name Contents
Δ of Doom (medial) 1.    Iliac vessels

2.    Genital branch of Genitofemoral nerve

Δ of Pain (lateral) 1.    Lateral femoral cutaneous nerve of thigh (MC-ly injured)

2.    Femoral nerve

3.    Femoral branch of Genitofemoral nerve

Δ of Doom + Δ of Pain = Trapezoid of Disaster.


 

 

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