Label Key pelvic Landmarks
What are the 3 key pelvic Ligaments
Inguinal: ASIS → Pubic Tubercle, formed from the rolled edge of ext. oblique aponeurosis
Lacunar: connects inguinal and pectinate ligaments
Pectineal: pectineal line of pubic bone.
What is the inguinal canal? How does it differ in males vs females?
- Oblique (to prevent herniation) passage thorugh lower part of abd. wall, ~4cm long
- From Deep Inguinal Ring to the Superficial Inguinal Ring
Males: carries structures to/from testis and abdomen via the Spermatic cord (+ilioinguinal nerve)
Females: Carries round lig. of the uterus from the pelvis to the labia majora (+ilioinguinal nerve)
Superficial Inguinal "Ring" (External oblique).
Triangular shaped defect (nnot actually a ring) in Ext. Oblique aponeurosis
- Sup/lat to Pubic Tubercle
- Margins (crura) give rise to Ext. Spermatic Fascia of spermatic cord
Deep Inguinal Ring (transversalis Fascia)
Oval opening of Transversalis Fascia
- Mid-inguinal point (halfway between ASIS and Pubic symphysis)
- ~1.5-2cm above inguinal lig.
- Lateral to Inferior Epigastric Artery
TF gives rise to Internal Spermatic fascia (spermatic cord)
Round ligament fascia in women
What are the 2 muscle layers between DIR and SFIR that contribute to the inguinal canal? Where do they meet?
Transversus Abdominis (doesn't contribute to spermatic fascia) and Internal Oblique (gives rise to Cremaster muscle layer of spermatic cord)
Form common 'Conjoint Tendon' on the pubic crest/pectineal line
What constitutes the borders of the Inguinal Canal, ant, post, floor and roof?
Anterior: Aponeurosis of Ext. Oblique and Int. Oblique (lat 1/3)
Posterior: Transversalis Fascia and Conjoint tendon (med. 1/3)
Floor: Inf. rolled edge of Ext. Oblique aponeurosis (inguinal lig) and Lacunar Ligament (medial)
Roof: Fibres of Int. Oblique and Transversus Abdominis
What's Hesselbach's (inguinal) Triangle
- Site of Direct Hernia: pushes through weakened abdominal wall
- Corresponds to weak anterior wall (SFIR)
Borders: inguinal ligament, Inf. epigastric artery, lateral border of Rectus abdominis
What is the Spermatic Cord and how does it arise?
It's a collection of Structures which pass along the male inguinal canal to/from testis
Begins @ DIR, ends @ Testis
Arises from a peritoneal diverticulum called the 'Processus Vaginalis', pushes through the abdominal wall taking a tubular sheath from each layer
What makes the 3x tubular sheath layers of the Spermatic Cord?
Transversalis Fascia (DIR) → Internal Spermatic Fascia
((Transversus abdominis contributes NOTHING))
Internal Oblique → Cremaster Muscle
External Oblique → External Spermatic Fascia
*Peritoneal out-pouching eventually pinches off leaving a remnant closed off sac "Tunica Vaginalis"
What are the contents of the Spermatic Cord (within the 3x layers)?
- Testicular a. (from L2 abdo. aorta, supplies testis and epididymis)
- Artery of Vas Deferens (important for Vasectomy!)
- Cremasteric a.
- Genital branch of Genitofemoral n. (M(cremaster muscle) and S(skin of scrotum) @ L1-2)
Sympathetic Nerves (from testicular plexus)
- **ilioinguinal n (doesn't actually travel in cord!)
3 Other Structures:
- Vas Deferens
- Tunica Vaginalis
1 Venous Plexus
- Pampiniform Plexus (for temp reg.)
Draw in the spermatic cord contents!
Lymphatics of the spermatic cord?
Drain to the Para-aortic nodes @L2 (origin of testicular artery)
Why is the Ilioinguinal Nerve not actually part of the spermatic Cord?
Bc it DOESN'T travel in the cord NOR does it 'travel through' the inguinal canal.
- Pierces through the Int. Oblique (roof), runs outsde cord and exits the SIR.
Testicular Torsion? Symptoms?
- When the Spermatic cord twists around, cutting off blood supply (→ ischaemia)
- Surgical emergency! Only a 6hr window to save testis
-Acute and sever testicular/scrotal pain
-Pain referred to groin and lower abd.
-Absent/decreased cremasteric reflex
Normal Cremasteric Reflex?
- Stroke Sup. Medial thigh
- Stimulates sensory fibres of Femoral branch of GF nerve and ilioinguinal nerve (L1-2)
- This stimulates motor fibres of Genital branch of GF n. ⇒ Cremaster muscle contracts on ipsilateral side, raising testis!
Whats usually more reliable then Cremaster reflex method?
Ultrasound can see torsion via lack of testis blood flow
Direct Inguinal Hernia
- Abdo. contents herniate through weak spot in fascof posterior wall of Inguinal canal (Hesselbachs triangle)
- MEDIAL to Inf. Epigastric a.
Males 10x more likely
middle aged to Elderly more likely
Indirect Inguina Hernia
- Can be a congenital defect
- Occurs through DIR and through entirety of Inguinal canal → Scrotum within spermatic Cord
- LATERAL to inf. Epigastric a.
- Often seen in juveniles as DIR stil overlapped by SIR