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Boundaries

Lateral

• Deep inguinal ring
• Opening in fascia transversalis
• 1 cm above the inguinal ligament
• Midway between anterior superior iliac spine and symphysis pubis
• Medial to it lie the Inferior Epigastric vessels

Medial

• Superficial inguinal ring
• Triangular defect in external oblique aponeurosis
• Overlies the pubic crest which forms the base of the opening

Anterior wall

• External oblique aponeurosis
• Reinforced in lateral 1/3 by internal oblique muscle

Posterior wall

• Fascia transversalis
• Reinforced in medial 1/3 by conjoint tendon

Floor

• Inguinal ligament
• Lower border of external oblique aponeurosis
• Medially is continuous with lacunar ligament
• Gives attachment to fascia lata on the inferior border

Roof

• Arched fibres of conjoint tendon

Contents of inguinal canal

• Spermatic cord and ilioinguinal nerve in males
• Round ligament of uterus and ilioinguinal nerve in females

Coverings of spermatic cord

• Each anterior abdominal wall layer gives it a covering to sheath
• From within outwards the coverings are derived as follows
  • Internal Spermatic fascia from fascia transversalis
  • Cremasteric fascia from internal oblique
  • External spermatic fascia from external oblique

Contents of spermatic cord

• Vas deferens
• Artery to vas deferens (branch of inferior vesical artery)
• Testicular artery (branch of abdominal aorta)
• Testicular vein
• Testicular lymphatics
• Testicular nerve fibres
• Processus vaginalis
• Cremasteric artery (branch of inferior epigastric artery)
• Nerve to cremaster (genital branch of genitofemoral nerve)

Hesselbach’s Triangle

• Boundaries
  • Medial half of inguinal ligament
  • Linea semilunaris (lateral border of rectus abdominis)
  • Inferior epigastric artery
• Surgical importance
  • Not reinforced by conjoint tendon
  • Potentially weak area
  • Direct Inguinal hernias protrude through it

Author:  Dr Shakeeb Khan

Last updated: 21 April 2009

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