Anatomy

of the

Umbilical
and

Inguinal Region

Inguinal anatomy: lecture objectives

Understand the anatomic features of the
inguinal canal
Know the components of the spermatic
cord
Understand the concept of abdominal wall
hernia
Know the difference between direct and
indirect inguinal herniation
Become familiar with femoral and umbilical
hernia

Umbilicus site of skin fixation to linea alba, congenital

weakness due to passage of umbilical cord during fetal
development and varying degrees of fusion of fascia, a
congenital umbilical hernia can form at this site due to lack
of fusion of the fascia or increased intraabdominal pressure
may lead to an acquired umbilical hernia

Inguinal canal

The inguinal canal is oblique and runs parallel to

the inguinal ligament, abdominal wall contraction
normally decreases the dimensions of the canal

Effect of abdominal wall

contraction

External/superficial inguinal ring

Deep inguinal ring

Inguinal Canal
Oblique and infero-medially oriented
Parallel to and above inguinal ligament
Contains spermatic cord in males round
ligament of uterus in females both have
similar embryologic origins
Ilioinguinal nerve emerges along with
spermatic cord/round ligament through
superficial ring

Inguinal Canal
Roof - arch of internal oblique and
transverse abdominus muscle
Floor inguinal ligament
Anterior wall aponeurosis of external
oblique muscle
Posterior wall transversalis fascia

Spermatic cord
Follows the testicle from site of embryonic
origin in posterior abdominal wall to scrotal
sac of full term male child
Carries sperm from testicle to urinary tract
Carries arteries and veins
Carries lymphatic and innervation
Encased in spermatic fascia

Spermatic cord contents

ductus deferens (vas deferens) which carries

semen from seminal vesicles and the small
artery deferential artery which nourishes the
vas
spermatic artery, a branch of the aorta
pampiniform venous plexus returns
venous blood to IVC or renal vein
genital branch of genitofemoral nerve
Lymphatics draining the testis
Cremasteric artery branching from the
inferior epigastric artery

Fascial layers of spermatic cord

Internal spermatic fascia continuation

of transversalis fascia, holds vas deferens,
lymphatics, nerves and blood vessels
Cremasteric fascia continuation of
internal oblique muscle
External spermatic fascia - thin layer,
continuation of external oblique
aponeurosis

Layers of the spermatic cord

Exposed inguinal and femoral region

 The inguinal
ligament is the
landmark
dividing
abdomen and
lower extremity
The pubic
tubercle is the
landmark used
to find the
external
inguinal ring

Cross-sectional
view inguinal
canal

Development of Inguinal Canal

Gonads develop in the posterior
abdominal wall
The gubernaculum (a fibrous cord)
connects the embryonic gonads to the
inguinal region
Overlying peritoneum processus
vaginalis is carried with gonads as they
migrate into the scrotum

Descent of round ligament of ovary in

The retroperitoneal origin of the testes results in

lymphatic drainage to the preaortic lymph nodes

Components of a hernia

Components of a hernia

Ring or defect

Definitions
Abdominal Hernia a protrusion of
intraabdominal structure through a defect in the
abdominal wall
Hernial defect or ring the weakness or
absence of abdominal fascia at the site of a
hernia, any failure of healing of an abdominal
incision will likely become a hernia due to a
defect of healing of abdominal wall
Hernial sac the peritoneum and adjacent fatty
tissue or even viscera which compose the wall of
the hernia

Definitions
Inguinal Hernia a hernia occurring at
the region of the internal ring (indirect) or
inguinal triangle (direct)
Femoral hernia a hernia occurring at
the femoral canal, medial to the femoral
vein and just posterior to the inguinal
ligament

Hernia adjectives

Reducible contents of hernia able to return

to abdominal cavity with recumbency or
external pressure
Incarcerated contents of hernia NOT able to
be returned to abdomen with external pressure
Strangulated contents of hernia rendered
ischemic due to obstruction of arterial/venous
flow due to pressure within the hernia

Umbilical hernia : laparoscopic view

Rt indirect inguinal hernia- lateral to inferior

epigastric vessels intraperitoneal view
Inferior
Epigastric
vessels

sac

Spermatic cord

bowel

Inguinal anatomy: posterior view right side

inferior epigastric vessels

Indirect inguinal hernias pass through the inguinal canal

LATERAL to the inferior epigastric vessels, direct inguinal
hernias pass MEDIAL to the inferior epigastric vessels
through the inguinal triangle

Frequency of hernia location by gender

Clinical aspects of groin hernias

Indirect inguinal hernia patent processus
vaginalis present at birth (congenital) may
be diagnosed at birth or years later as it
dilates courses along with spermatic cord or
round ligament through both the internal and
external inguinal rings. Therefore it runs
through the inguinal canal. It is the most
common type of inguinal hernia in both
sexes. The hernia originates lateral to
inferior epigastric vessels

Clinical aspects of groin hernias

Direct inguinal hernia forms later in life
(acquired) as a weakness in Inguinal
Triangle (Hesselbachs triangle) and then
passes through the superficial inguinal
ring. The hernia originates medial to
inferior epigastric vessels. Boundaries of
inguinal triangle are medial border of
rectus sheath

Clinical aspects of groin hernias

Femoral hernia - least common of all
types though most often in females,
passes through acquired weakness in
femoral canal inferior to inguinal ligament,
does not overly pubic tubercle as inguinal
hernias do. Because of very small tight
neck, bowel when incarcerated often
becomes strangulated/ischemic necrosis

Variants of the patent processus vaginalis

 The processus vaginalis normally

obliterates at birth.
Persistence of the processus vaginalis
often leads to indirect inguinal hernia
becoming clinically evident at any time of
life.
Many variations of this abnormality can
occur i.e. hydrocele, communicating
hydrocele