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What is the inguinal canal in terms of anatomy?

Inguinal canal, canalis inguinalis, represents the gap through which passes the spermatic cord, funiculus spermaticus, in men and the round ligament of the uterus, lig. teres uteri, in women (for more information on these organs, see the Splanchnology section). It is placed in the lower abdominal wall on either side of the abdomen, immediately above the inguinal ligament, and goes from top to bottom, from the outside inward, from back to front.

Its length is 4.5 cm. It is formed as follows: the internal oblique and transverse muscles grow to the outer two-thirds of the groin of the inguinal ligament, but they do not have this fusion throughout the medial third of the ligament and freely spread through the spermatic cord or round ligament. Thus, between the lower edges of the internal oblique and transverse muscles above and the medial part of the inguinal ligament from below, a triangular or oval fissure is obtained in which one of the mentioned formations is embedded.

This gap is the so-called inguinal canal. From the lower edge of the internal oblique and transverse muscles hanging over the spermatic cord, the bundle of muscle fibers accompanying the cord into the scrotum departs to the last, m. cremaster (muscle raising the testicle).

The slit of the inguinal canal is closed in front by the aponeurosis of the external oblique muscle of the abdomen, passing below into the inguinal ligament, and behind it is covered fascia transversalis. Thus, four walls can be distinguished in the inguinal canal. The front wall is formed by the aponeurosis of the external oblique muscle of the abdomen, and the back - fascia transversalis, the upper wall of the channel is represented by the lower edge of the internal oblique and transverse muscles, and the lower - by the inguinal ligament.

In the front and back walls of the inguinal canal there is a hole, called the inguinal ring, superficial and deep.

Superficial inguinal ring, annulus inguinalis superficialis (in the anterior wall), formed by the divergence of the fibers of the aponeurosis of the external oblique muscle into two legs, of which one, crus lateraleattached to tuberculum pubicum and the other, crus mediale, - to the pubic symphysis. In addition to these two legs, another third (back) leg of the surface ring is described, lig. reflexumlying already in the inguinal canal behind the spermatic cord.

This leg is formed by the lower fibers of the aponeurosis m. obliquus externus abdominis of the opposite side, which, crossing the midline, pass behind the crus mediale and merge with the fibers of the inguinal ligament. The limited crus mediale and crus laterale superficial inguinal ring has the shape of an oblique triangular gap. The acute lateral angle of the slit is rounded off by arched tendon fibers, fibrae intercruralesoccurring due to fasia covering m. obliquus externus abdominis.

The same fascia in the form of a thin film descends from the edges of the superficial inguinal ring to the spermatic cord, accompanying the latter into the scrotum called fascia cremasterica.

Deep inguinal ring, annulus inguinalis profundus, located in the region of the posterior wall of the inguinal canal formed by fascia transversalis, which extends from the edges of the ring to the spermatic cord, forming a membrane surrounding it with the testicle, fascia spermatica interna. In addition, the posterior wall of the inguinal canal is supported in its medial section by tendon fibers extending from aponeurotic stretching. m. transversus abdominis and descending along the edge of the rectus muscle down to the inguinal ligament. This is the so-called falx inguinalis.

The peritoneum covering this wall forms two inguinal fossae, fossae inguinales, separated from each other by sheer folds of the peritoneum, called umbilical. These folds are as follows: the most lateral - plica umbilicalis lateralis - is formed by raising the peritoneum passing under it a. epigastrica inferiormedial - plica umbilicalis medialis - contains ligamentum umbilicale mediatei.e. overgrown a. umbilicalis embryo, median - plica umbilicalis mediana - covers lig. umbilicale medianum, overgrown urinary tract (urachus) of the embryo.

Lateral inguinal fossa, fossa inguinalis lateralis, located laterally from plica umbilicalis lateralisjust matches the deep inguinal ring, medial fossa, fossa inguinalis medialislying between plica umbilicalis lateralis and plica umbilicalis medialis, corresponds to the weakest part of the posterior wall of the inguinal canal and is placed just against the superficial inguinal ring.

Through these fossae, inguinal hernias can protrude into the inguinal canal, and a lateral (external) oblique hernia passes through the lateral fossa, and a medial (internal) direct hernia passes through the medial fossa. The origin of the inguinal canal is due to the so-called lowering of the testicle, descensus testis, and the formation of peritoneum procesus vaginalis in the embryonic period (see the section “Splanchnology” for more on this).

What is the inguinal canal?

The inguinal canal in men is located in an area in the abdominal wall. Doctors call the inguinal canal a slanting gap, which varies slightly between men and women. The length of the male inguinal canal is about 6 cm, and its width is 1-2.5 cm. Due to the location of the testes and prolapse of the testicles, the inguinal canal is somewhat larger in men than in women.

The inguinal canal is formed due to the growth of the internal oblique and transverse muscles to the outer two-thirds of the groin of the inguinal ligament, and throughout the medial third of the ligament, the muscles do not grow together, freely spreading through the round ligament (spermatic cord). That is, we can say that the inguinal canal is a triangular or slightly oval gap that forms between the transverse muscle and the lower edges of the internal oblique muscle.

The structure of the inguinal canal

To study this section of the body in more detail, a man needs to know the structure of the inguinal canal. The inguinal triangle is limited to several parts:

  • lower part - here is the Pupartova bunch,
  • medial ligament of muscles - the outer edge of the rectus abdominis muscle,
  • upper part - the inguinal canal is bounded perpendicularly, dropping from the point between the external and middle third of the inguinal ligament to the rectus abdominis muscle.

Also, the structure of the groin in a man considers the outer and inner holes, as well as four walls. Namely:

  1. Inner hole - This is an inguinal deep ring that is located one and a half centimeters higher from the middle of the inguinal ligament. This is a hole in the transverse fascia, where the spermatic cord passes directly. This hole is called the lateral inguinal fossa, which is limited in structure by the inguinal ligament on top, the external umbilical fold from the inside.

2 Outer hole - the inguinal ring located outside, limited to the lateral and medial legs, interfibular fibers on top, bent by a bundle of muscles from the inside.

Also, the anatomy of the structure of this part of the male body examines several walls of the inguinal canal, namely:

  • aponeurosis of the external oblique muscle of the abdomen - located in front of the groin,
  • transverse fascia - it is located on the back of the groin,
  • inguinal ligament - can be seen from the bottom of the structure,
  • the internal oblique and transverse muscles of the abdomen (overhanging their edges) - located on top of the groin.

If we consider the male body, the inguinal canal conducts the spermatic cord inside itself, there are also the ilio-inguinal nerve and the genital branch of the femoral-genital nerve. And the part that begins on the upper wall of the inguinal canal and ends on the lower wall is called the inguinal gap in medicine.

Weaknesses of the inguinal canal and possible pathologies

In men, due to structural features, the inguinal canal is vulnerable to certain diseases, most often it is an inguinal hernia. The vulnerability of the channel lies in the fact that some of its organs are outside and have a bulging structure. Medicine names several vulnerabilities in a man's groin:

  • the inguinal canal itself and its fossa, where hernias often appear,
  • the supravesical fossa, which is located between the folds of the peritoneum near the navel above the bladder (not only inguinal, but also sliding hernias occur),
  • the inner femoral ring, respectively, femoral hernias in the fold and inguinal ligament of the muscles can occur here,
  • groin obstruction,
  • umbilical ring and, respectively, umbilical hernia,
  • a white line in the groin area where aponeurosis defects may occur.

If we study in detail the anatomy of the structure of the entire inguinal canal, we can say that it is poorly protected by nature from injuries, disorders and pathologies. There are frequent cases in medicine when some organs went out through the inguinal canal, as a result of which a hernia was established. In addition, the groin includes important organs responsible for the reproductive, urinary and sexual functions of men.

In this case, the entire inguinal canal is protected by the body by the location of different muscles. But there is another side to the coin, for example, with increasing pressure, internal organs can be squeezed, which squeezes each other. Such factors as weight lifting, severe coughing, chronic constipation, as well as prostate adenoma and proliferation of glandular tissues can provoke hernias and other disorders.

Conclusion

The inguinal canal is a section of the male body that consists of muscle tissue that forms a triangle on the surface of the lower abdomen. The external genitalia, that is, the penis, testes and scrotum, can also be included in its composition, but the anatomy of the structure of the inguinal canal only considers muscles. The boundaries of the inguinal canal are limited by several sides - the aponeurosis of the external oblique muscle, the pupartic ligament, the transverse fascia, as well as the internal oblique and transverse muscle of the abdomen. More detailed points of the structure can be viewed on the scheme of the inguinal canal.

The inguinal canal openings:

superficial inguinalring formed by diverging medial and lateral legs of the aponeurosis of the external oblique muscle of the abdomen, fastened by inter-leg fibers, rounding the gap between the legs into a ring,

deep inguinalring it is formed by the transverse fascia and represents its funnel-shaped retraction during the transition from the anterior abdominal wall to the elements of the spermatic cord (uterus round ligament); the lateral inguinal fossa corresponds to it from the side of the abdominal cavity.

Walls of the inguinal canal:

front - aponeurosis of the external oblique muscle of the abdomen,

back - transverse fascia,

top - overhanging edges of the internal oblique and transverse muscles,

lower - inguinal ligament.

The gap between the upper and lower walls of the inguinal canal is called the inguinal gap.

spermatic cord (in men) or round ligament of the uterus (in women),

genital branch of the femoral-genital nerve.

The femoral canal is formed during the formation of a femoral hernia (when the hernial sac exits from the abdominal cavity in the femoral fossa, between the superficial and deep leaves of its own fascia, and emerges under the skin of the thigh through the oval fossa).

Femoral openingschannel:

inner hole corresponds to the femoral ring, which is limited to:

in front - inguinal ligament,

back - comb ligament,

medially - lacunar ligament,

lateral - femoral vein,

outer hole - subcutaneous fissure (the oval fossa receives this name after rupture of the ethmoid fascia).

front - the surface leaf of the own fascia of the thigh (in this place it is called the upper horn of the crescent edge),

back - a deep leaf of the own fascia of the thigh (in this place it is called the comb fascia),

lateral - the vagina of the femoral vein.

Features of the anterolateral wall of the abdomen in newborns and children

In infants, the abdomen has the shape of a cone, facing the narrow part down. The anterior abdominal wall in infancy protrudes forward and slightly sags, which is associated with insufficient muscle development and aponeurosis. In the future, when the child begins to walk, with an increase in muscle tone, the bulge gradually disappears.

The skin of the abdomen in children is soft, subcutaneous fat is relatively large, especially in the suprapubic and inguinal areas, where its thickness can reach 1.0-1.5 cm. The superficial fascia is very thin and has a single leaf even in full and physically developed children. The muscles of the abdominal wall of children under one year old are poorly developed, aponeurosignal and relatively wide. As the child grows, muscle differentiation occurs, and the aponeurotic part of them gradually decreases and

thickens. Between the spigel line and the lateral edge of the rectus abdominis muscles, from the costal arch to the pupartic ligament, aponeurotic stripes are 0.5 to 2.5 cm wide on both sides. These sections of the abdominal wall are the weakest in young children and can serve as the sites for the formation of hernial protrusions ( hernia of the Spigel line). The vagina of the rectus abdominis muscle is poorly developed, especially its posterior wall.

The white line of the abdomen in infants is distinguished by a relatively large width and small thickness. Downward from the umbilical ring, it gradually narrows and passes into a very narrow strip. In the upper part of it, near the navel, thinned areas are often observed in which defects between the aponeurotic fibers are found in the form of elongated narrow gaps. Through some of them, neurovascular bundles pass. They are often the gates of hernias of the white line of the abdomen. The transverse fascia and parietal peritoneum of small children are in close contact with each other, since preperitoneal fatty tissue is not expressed. It begins to form the last two lives, with age, its number increases, especially sharply during puberty.

The inner surface of the anterior abdominal wall in younger children looks smoother than in adults. The supravesical fossa is almost absent. In the lateral umbilical-cystic folds, umbilical arteries are still passable for some time after the generation. The blood vessels located in the layers of the anterior abdominal wall are very elastic in young children, they are easily collapsed and bleed little when cut.

After the umbilical cord falls off (5–7 days of postpartum), in its place as a result of fusion of the skin with the edge of the umbilical ring and the parietal sheet of the peritoneum, an “navel” is formed, which is an inverted connective tissue scar. Simultaneously with the formation of the navel, the closure of the umbilical ring occurs. The most dense is its lower semicircle, where three connective tissue strands corresponding to obliterated umbilical arteries of the canal duct end. During the first weeks of a child’s life, the last ones, together with the barton jelly that covers them, transform

seam in dense scar tissue and, fused with the lower edge of the umbilical ring, provide its tensile strength. The upper half of the ring is weaker and can serve as a place for the exit of hernias, since a thin-walled umbilical vein passes here, covered only by a thin layer of connective tissue and umbilical fascia. Umbilical fascia in newborns sometimes does not reach the upper edge of the umbilical ring, creating an anatomical prerequisite for the formation of hernial collars. In one-year-old children, the fascia completely or partially closes the umbilical region.

In young children, the inguinal canal is short and wide, and the direction is almost straight - front to back. With the growth of the child, as the distance between the wings of the ilium increases, the course of the canal becomes oblique, its length increases. The inguinal canal of newborns and often in children of the first year of life is lined with the serous membrane of an overgrown vaginal process of the peritoneum.

Inguinal canal -

Inguinal canal, canalis inguinalis, is the gap through which the spermatic cord, funiculus spermaticus, in men and the round ligament of the uterus, lig. teres uteri, in women. It is placed in the lower abdominal wall on either side of the abdomen, immediately above the inguinal ligament, and goes from top to bottom, from the outside inward, from back to front. Its length is 4.5 cm. It is formed as follows: the internal oblique and transverse muscles grow to the outer two-thirds of the groin of the inguinal ligament, but they do not have this fusion throughout the medial third of the ligament and freely spread through the spermatic cord or round ligament.

Thus, between the lower edges of the internal oblique and transverse muscles above and the medial part of the inguinal ligament from below, a triangular or oval fissure is obtained in which one of the mentioned formations is embedded. This gap is the so-called inguinal canal. From the lower edge of the internal oblique and transverse muscles hanging over the spermatic cord, the bundle of muscle fibers accompanying the cord into the scrotum departs to the last, m.cremaster (muscle raising the testicle).

The slit of the inguinal canal is closed in front by the aponeurosis of the external oblique muscle of the abdomen, passing below into the inguinal ligament, and behind it is covered by fascia transversalis.

Thus, four walls can be distinguished in the inguinal canal. The front wall is formed by the aponeurosis of the external oblique muscle of the abdomen, and the posterior - fascia transversalis, the upper wall of the canal is represented by the lower edge of the internal oblique and transverse muscles, and the lower - by the inguinal ligament. In the front and back walls of the inguinal canal there is a hole, called the inguinal ring, superficial and deep.

The superficial inguinal ring, annulus inguinalis snperficialis (in the anterior wall), is formed by the divergence of the fibers of the aponeurosis of the external oblique muscle into two legs, of which one, crus laterale, attaches to tuberculum pubicum, and the other, crus mediale, to the pubic symphysis. In addition to these two legs, a third (back) leg of the surface ring, lig, is described. reflexum, which lies already in the inguinal canal behind the spermatic cord. This leg is formed by the lower fibers of the aponeurosis m. obliquus externus abdominis of the opposite side, which, crossing the midline, pass behind the crus mediale and merge with the fibers of the inguinal ligament. The limited crus mediale and crus laterale superficial inguinal ring has the shape of an oblique triangular gap. The acute lateral angle of the slit is rounded off by arcuate tendon fibers, fibrae intercrurales, occurring due to fasia covering m. obliquus externus abdominis. The same fascia in the form of a thin film descends from the edges of the superficial inguinal ring to the spermatic cord, accompanying the latter into the scrotum called fascia cremasterica.

The deep inguinal ring, annulus inguinalis profundus, is located in the region of the posterior wall of the inguinal canal formed by fascia transversalis, which extends from the edges of the ring to the spermatic cord, forming the membrane surrounding it with the testicle, fascia spermatica interna. In addition, the posterior wall of the inguinal canal is supported in its medial section by tendon fibers extending from aponeurotic stretching m. transversus abdominis and descending along the edge of the rectus muscle down to the inguinal ligament. This is the so-called falx inguinalis.

The peritoneum covering this wall forms two inguinal fossae, fossae inguinales, separated from each other by sheer folds of the peritoneum, called umbilical. These folds are as follows: the most lateral - plica umbilicalis lateralis - is formed by raising the peritoneum passing under it a. epigastrica inferior, medial - plica umbilicalis medialis - contains ligamentum umbilicale mediate, i.e., overgrown a. germ umbilicalis, median - plica umbilicalis mediana - covers lig. umbilicale medianum, overgrown urinary tract (urachus) of the embryo.

The lateral inguinal fossa, fossa inguinalis lateralis, located laterally from plica umbilicalis lateralis, just corresponds to the deep inguinal ring, the medial fossa, fossa inguinalis medialis, lying between plica umbilicalis lateralis and plica umbilicalis medialis, corresponds to the weakest canal of the posterior wall times against superficial inguinal ring. Through these fossae, inguinal hernias can protrude into the inguinal canal, and a lateral (external) oblique hernia passes through the lateral fossa, and a medial (internal) direct hernia passes through the medial fossa.

The origin of the inguinal canal is associated with the so-called lowering of the testicle, descensus testis, and the formation of the peritoneum procesus vaginalis in the embryonic period.

Anatomy

In P. about. an inguinal triangle is formed, formed by a horizontal line running from the border of the outer and middle third of the inguinal ligament to the outer edge of the rectus abdominis muscle (above), the inguinal ligament (bottom) and the outer edge of the rectus abdominis muscle (from the inside). In the inguinal triangle between the lower edges of the internal oblique and transverse muscles of the abdomen and the groin of the inguinal ligament there is a muscle defect called the inguinal gap (Fig. 1). In the lower inner corner of the inguinal triangle there is an inguinal canal (see), which contains the spermatic cord in men and the uterine ligament in women. Leather in P. about. thin, mobile, it has sweat and sebaceous glands, as well as hair follicles. The subcutaneous tissue is bilayer, penetrated by connective tissue fibers. In the area of ​​the inguinal ligament, where these fibers are connected with the wide fascia of the thigh, an inguinal fold is formed. The superficial fascia consists of two leaves, of which the deepest is more dense and is called the iliac-comb (Thomson-howl) fascia. In the subcutaneous tissue pass superficial epigastric artery (a.epigastrica superficialis), superficial artery, envelope of the ilium (a.circumflexa ilium superficialis), and the external genital artery (a. Pudenda ext.), Accompanied by the same veins. Lymph, vessels in the subcutaneous tissue form looped plexuses and flow into the superficial inguinal nodes. Skin P. about. it is innervated by the branches of the 12 intercostal nerve, the iliac-submandibular (n. iliohypogastricus), iliac-inguinal (n. ilio inguinalis) and femoral-genital (n. geni-tofemoralis) nerves. Own fascia covers the external oblique muscle of the abdomen and, together with a deep leaf of the superficial fascia, attaches to the inguinal ligament. The lateral muscles of the abdominal wall - the external and internal oblique muscles of the abdomen (mm. Obliqui ext. Et int. Abdominis) and the transverse abdominal muscle (m. Transversus abdominis) - are located sequentially in three layers (see Abdominal wall). The lower edge of the aponeurosis m. obliqui ext. abdominis is involved in the formation of the inguinal ligament and is divided into 2 legs: medial (crus med.) and lateral (crus lat.). In 10% of cases, a bent ligament (lig. Reflexum) is found. The medial and lateral legs, attaching to the pubic tubercle and the upper edge of the symphysis, form a superficial inguinal ring, which is limited to the outside by arcuate fibers. The inguinal (pupartic) ligament in its structure is a complex formation, not only three lateral abdominal muscles originating from it participate in it, but also the fascia of the abdominal wall and thigh. In the intermuscular spaces of the lateral abdominal muscles there are fascial leaves, loose fiber and branches of the 12 intercostal nerve, iliac-hypogastric and iliac-inguinal nerves pass. From the internal oblique and transverse (in 25% of cases) muscles, the muscle fibers that form the muscle that lifts the testicle (m. Cremaster) are separated. The transverse abdominal muscle in the area of ​​the inguinal gap has an arched course of muscle fibers, forming an inguinal arch above the inguinal ligament. There are 2 forms of the inguinal gap: slit-oval and triangular. In the inguinal ligament, the transverse muscle covers the deep ring of the inguinal canal, then passes into the tendon aponeurosis, spreading through the spermatic cord, and ends at the pubic tubercle, weaving into the lacunar ligament and forming the inguinal sickle (falx inguinalis). Sometimes there is a joint tendon of the internal oblique and transverse muscles of the abdomen. On the lateral side, the inguinal space is strengthened by the inter-urorenal ligament (lig. Interfoveola-ge). Deep layers P. of the lake .: transverse fascia, preperitoneal fiber and peritoneum. The transverse fascia (fascia transversalis) in the inguinal ligament has a denser structure, forming a strip 1 cm wide (ileo-pubic cord). The outer part of the transverse fascia is fused with the inguinal ligament, and the inner part is with the pubic (Cooper). Preperitoneal fiber is a layer of loose connective tissue. The parietal peritoneum forms in P. about. a number of folds and dimples (see. Abdominal wall). The spermatic cord is accompanied by: cremasteric arteries and veins (vasa cremasterica), testicular artery and veins (vasa testicularia), artery and veins of the vas deferens (A. et v. Ductus deferentis). In the interfascial cellular space, then in the retroperitoneal tissue, deep arteries and veins pass around the ilium (vasa circumflexa ilii profunda), which are directed along the inguinal ligament.

Pathology

From congenital anomalies and acquired structural defects P. about. hernias are most often met (see).

Of the inflammatory processes, a boil (see), carbuncle (see), hydradenitis (see), lymphadenitis of superficial lymph nodes, nodes (see Lymphadenitis), developing as a result of infection from inflammatory foci localized by hl, are often observed. arr. on the skin of the external genitalia and the anteromedial surface of the thigh, sometimes the lower leg and foot. Specific inguinal lymphadenitis is characteristic at primary syphilis (see) and a soft chancre (see). With a soft chancre, purulent fusion of lymph and nodes often occurs with the formation of a typical ulcer in the groin. In P. about. sometimes cold sore abscesses arising from tuberculous spondylitis come down (see).

Operations

By. of great interest in surgery from the point of view of choosing the safest operative accesses to the iliac blood vessels, abscesses and phlegmon located in the subperitoneal part of the pelvis (see Pirogova section). In addition, through P. about. operative accesses are made to the contents of the inguinal canal (see) with inguinal hernias (see) and with funicular (see Semen cord).

Bibliography: Venglovsky R. I. On the descent of the testicle, in the book: Works of hospitals. chir. Clinics, ed. P.I. Dyakonov, v. 1, p. 7, M., 1903, a. Development and “structure of the inguinal region, their relation to the etiology of inguinal hernias, M., 1903, 3 o-lotareva T. V. Surgical anatomy of the anterior-lateral wall of the abdomen, in the book: Khir . Anat, Belly Ed. .A. N. Maksimenkova, p. 23, JI., 1972, K u-kudzhanov N.I. Inguinal hernias, M., 1969, JI ubotskii D.N. Fundamentals of topographic anatomy, p. 458, M., 1953, Ostroverkhov G. E, JI at b about ts-to and y D.N. and Bomash Yu. M. Operative surgery and topographic anatomy, M., 1972.


G. E. Ostroverkhov, A. A. Travin.

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