ANTERIOR ABDOMINAL WALL Part 3

SPERMATIC CORD – COVERINGS AND CONTENTS (SE)     
Coverings of spermatic cord :
  From within outwards,
       Internal spermatic fascia – derived from fascia transversalis
  Cremasteric fascia – derived from the internal oblique muscle
        External spermatic fascia – derived from external oblique aponeurosis
                          



Contents of spermatic cord:
Vas deferens
Artery to vas deferens & sympathetic plexus around it
Cremasteric artery
Testicular artery
Pampiniform plexus of veins
Lymphatics from testis
Genital branch of Genitofemoral nerve
Remains of processus vaginalis


                                                  





PROTECTIVE MECHANISM OF INGUINAL CANAL (SE)                  
     Obliquity of inguinal canal
        Superficial & Deep inguinal ring don’t lie opposite to each other
        When intra abdominal pressure rises, anterior & posterior walls of canal approximate with each     other like a flap valve & obliterates the passage
     Guarding of inguinal rings
         Superficial inguinal ring is guarded from behind by conjoint tendon
         Deep inguinal ring is guarded from front by internal oblique muscle
     Shutter mechanism of internal oblique muscle
        Tmuscle forms the anterior wall, roof, floor of inguinal canal
        When the muscle contracts, the roof approximates to the floor like a shutter
     Ball valve mechanism
        Contraction of cremaster pulls the testis upwards & superficial inguinal ring is plugged by spermatic cord
     Slit valve mechanism
        Contraction of external oblique results in approximation of  2 crura of superficial inguinal ring like a     slit valve












INGUINAL HERNIA – TYPES & COVERINGS                     
          Protrusion of any of the abdominal contents through the inguinal wall or inguinal canal is called inguinal Hernia
Types of inguinal hernia:
      Direct inguinal hernia
  Indirect inguinal herni
                                                 
                                      


		Direct inguinal hernia	Indirect inguinal hernia
1.	Definition	protrusion of abdominal contents occurs through the weak posterior wall of inguinal canal  (Hesselbach’s triangle)	protrusion of abdominal contents occurs through the deep inguinal ring
2.	Congenital / Acquired	Acquired	Congenital or Acquired
3.	Etiology	Weakness of Abdominal wall muscles, factors increasing intra abdominal pressure like chronic cough, constipation	Persistence of patent processus vaginalis
4.	Age	Old	Children ,Young age
5.	Unilateral / bilateral	Bilateral	Unilateral / bilateral
6.	Relation to inferior epigastric artery	Medial	Lateral
7.	Enters inguinal canal  through	Inguinal triangle	Deep inguinal ring
8.	Hernial sac neck	wider	Narrow
9.	Coverings	From within outwards, Peritoneum Extra peritoneal tissue Fascia transversalis Cremasteric fascia External spermatic fascia Skin	From within outwards, Peritoneum Extra peritoneal tissue Internal spermatic fascia Cremasteric muscle & fascia External spermatic fascia skin

                                                       
 Coverings of indirect inguinal hernia         
fascia
fascia
                                        

                                                        


Coverings of direct inguinal hernia
fascia
                                                         

        


   


6.INDIRECT INGUINAL HERNIA (SE)
Indirect inguinal hernia is protrusion of abdominal contents through the deep inguinal ring
may be congenital/ acquired
              congenital – due to patency of processus vaginalis
              acquired – due to increased intra abdominal pressure
occurs in children ,young adults
predisposing factor is partial or complete patency of processus vaginalis.
may be unilateral or bilateral
hernia sac neck is narrower
lies lateral to inferior epigastric artery
Coverings:
      From within outwards,
Peritoneum
Extra peritoneal tissue
Internal spermatic fascia
Cremasteric muscle & fascia
External spermatic fascia
skin
fascia
fascia