Lecture 8: Inguinal Canal and Spermatic Cord Flashcards Preview

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What are the 9x layers of the abdominal wall?

1. Skin
2. Camper's Fatty Superficial fascia
3. Scarpa's Membranous Superficial fascia
4. External oblique
5. Internal Oblique
6. Transversus Abdominus
7. Transversalis Fascia
8. Extraperitoneal Fascia
9. Partial Perotineum


Key Pelvic Landmarks

ASIS: termination of illiac spine
Pectineal Line
Pubic Tubercle, Crest (posterior medial) and Symphysis (Linea Alba)
Inguinal Ligament


Clinical relevance of Pubic Tubercle

Can palpate
Useful if want to diagnose hernia's


Relationship b/w Pubic Crest and Tubercle

Pubic Crest is PosterioMedial to Pubic Tubercle


3x Key Pelvic Ligaments

1. Inguinal Ligament
2. Pectineal Ligament
3. Lacunar Ligament
Function of Pelvic ligaments: Attach suture during Inguinal hernia repairs. Will hold as all 3x are strong and robust ligaments


Inguinal Ligament

ASIS to Pubic Tubercle
Rolled free edge of External Oblique Aponeurosis


Pectineal Ligament

Pectineal line to Pubic bone


Lacunar Ligament

connects Inguinal and Pectineal Ligament
- sweeps horizontally onto pubic bones
- essentially a continuation of Inguinal ligament
Clinical: Sharp edges which thing scan get trapped against


Inguinal canal

Canal through which Pelvic Inguinal Ligament passes through (Lower part of the abdominal wall)
Oblique passage --> helps prevent herniation (of abdominal contents)
Superficial Inguinal Ring Deep Inguinal Ring (4 cm in adults) (runs superficial --> deep)


Inguinal Canal in Males and Females

Male Inguinal Canal: Has Spermatic cord carries structures too/from abdomen testes 2. Illioinguinal nerve alongside (in canal not in cord)
Female Inguinal Canal: 1. (Uterine) Round Ligament from pelvis Labia majora 2. Ilioinguinal nerve


Ilioinguinal nerve

Contained in Inguinal Canal in both males and female
Males: In Inguinal canal, Ontop (not inside) Spermatic Cord
- DOES NOT "travel through" inguinal canal technically --> Misses DIR and instead Pierces Internal Oblique Roof (of the canal) --> runs outside spermatic cord --> Exits at SIR
- therefore does not go through DIR
- Provides sensation around pubic region


Superficial Inguinal Ring

Aponeurosis of External Oblique --> Triangular Shaped
SuperioLateral to Pubic Tubercle
Crura= Margins --> Medial and Lateral Crus --> create the spermatic cords' (within male inguinal canal) External Spermatic Fascia
- Sometimes contains Transverse fibres for support


Deep Inguinal Ring

Transversalis Fascia Oval opening
1. Lateral to Inferior Epigastic artery.
2. Just past Mid-Inguinal Point (1.5- 2cm superior) --> 1/2 Way b/w ASIS and Pubic Symphsis
Creates Internal Spermatic Fascia of male Spermatic Cord --> Round Ligament in females


Transversus Abdominus and Internal Oblique

Located b/w Superficial and Deep Inguinal Ring
1. Transversus Abdominus: Doesnt contribute to spermatic fascia
2. Internal Oblique: Creates Cremasteric Muscle
- part of spermatic cord. comes of the scrotum
- helps draw testes towards body
Combined: Transversus Abdominus + Internal Oblique --> combine to form a CONJOINT TENDON
- on Pubic CREST / Pectineal Line


Borders of the Inguinal Canal

Anterior Wall: (Deep I. R)
1. External Oblique aponeurosis
2. Internal Oblique Lateral 1/3
Floor (ligaments for solidarity --> used for suturing herniation)
1. Inguinal ligament (rolled free edge of ext. oblique aponeurosis)
2. Lacunar Ligament
1. Internal Oblique
2. Transversus Abdominus
Posterior Wall: (Superficial I. R)
1. Transversalis Fascia
2. Conjoint Ligament (medial 1/3)


Draw Inguinal Canal diagram



Hesselback's (Inguinal) Triangle

1. Inferior Epigastric Artery
2. Inguinal Ligament
3. Rectus Abdominus (lateral border)
-Site of Direct Hernia (pushing through abdominal wall)
- Deep Inguinal ring located superiolateral
-Associated with weak anterior wall of Superficial Inguinal Ring


Spermatic Cord

Collection of structures, within male Inguinal canal, DIR (deep inguinal ring) testes
3x concentric layers of fascia. all derived from Anterior abdominal wall
- layers are continuous w. scrotum
- pushes through abdominal wall --> 3x concentric continuous layers (take a tubular sheath from each layer)
Spermatic Cord arises from Processus Vaginalis (a Peritoneal Diverticulum)
- Peritoneal (inner most abdominal layer) out-pouching pinches off --> forms closed sac --> remnant is newly named Tunica vaginalis


Layers of the Spermatic Cord

1. External Oblique (SIR) --> External Spermatic Fascia
2. Internal Oblique --> Cremaster Muscle
3. Transversus Abdominus (NO COVERING - hooks around)
4. Transversalis Fascia (DIR) --> Internal Spermatic Fascia


Scrotal Remnant

Innermost layer of abdominal cavity being pushed downwards by descending spermatic cord (Peritineum) --> eventually pinches off and forms a closed sac remnant structure --> Tunica Vaginalis


Contents of the Spermatic Cord

3x Layers:
1. 3x Arteries: a) Testicular (L2) b) Vas deferens/Deferential c) Cremasteric
2. 3x Nerves: a) Genital branch of Gentiofemoral (L1&2) b) Sympathetic nerves (from testicular plexus) c) Illioinguinal nerve L1 (within canal, ontop of cord)
3. 3x Other structures: a) vas deferens b) Lympahtics c) Tunica vaginalis
4. 1x Venous plexuses: Pampiniform plexus (runs entire way down plexus)


Why are the Testes external?

Testes external so can be relatively colder than body temp --> VENOUS PLEXUS heat exchange/dissipation --> optimum enviro. for sperm production


Testicular Artery

Abdominal aorta La
Supplied Testes and Epididymis


Vas deferens

Muscular duct
Transport spermatozoa from Epididymis Urethra


Artery of vas deferens

Accompanies Vas Deferens
IMPORTANT to be considered in order to avoid damaged during VASECTOMY


Pampiniform Plexus

Temperature regulation
Forms a single vein in DIR


Genital branch of Gentiofemoral nerve

Motor and sensory
1. Cremasteric Muscle
2. Skin of the Scrotum --> Therefore gentiofemoral nerve is located b/w External Spermatic Fascia + Cremasteric Muscle


Lymphatics in scrotal area

Drain to Para-aortic nodes in L2
- this is the origin of testicular arteries


Testicular Torsion

spermatic cord twists around --> cuts off blood supply --> ischaemia
Surgical emergency in 6 hours


Symptoms of Testicular Torsion

Acute and severe testicular pain (L1-2) --> Loin-Groin (referred to groin + lower abdomen)
- similar symptoms to similar pathologies in anatomical region (epididimytis)
Absent/Decreased cremasteric reflex
Nausea/ Vomitting
Redness/Pyrexia (inflammation)