![]() ![]() In contrast to the indirect hernia, direct inguinal hernias are acquired, usually in adulthood, due to weakening in the abdominal musculature. Large herniations are possible in which the peritoneal sac and its contents may traverse the entire inguinal canal, emerge through the superficial inguinal ring, and reach the scrotum. The degree to which the sac herniates depends on the amount of processus vaginalis still present. The peritoneal sac (and potentially loops of bowel) enters the inguinal canal via the deep inguinal ring. They are caused by the failure of the processus vaginalis to regress. Indirect inguinal hernias are the more common of the two types. Direct – where the peritoneal sac enters the inguinal canal though the posterior wall of the inguinal canal.īoth types of inguinal hernia can present as lumps in the scrotum or labia majora.Indirect – where the peritoneal sac enters the inguinal canal through the deep inguinal ring.Hernias involving the inguinal canal can be divided into two main categories: The walls of the inguinal canal are usually collapsed around their contents, preventing other structures from potentially entering the canal and becoming stuck.Ī hernia is defined as the protrusion of an organ or fascia through the wall of a cavity that normally contains it. Genital branch of the genitofemoral nerve – supplies the cremaster muscle and anterior scrotal skin in males, and the skin of the mons pubis and labia majora in females.This is the nerve most at risk of damage during an inguinal hernia repair. ![]() Note: only travels through part of the inguinal canal, exiting via the superficial inguinal ring (it does not pass through the deep inguinal ring).Ilioinguinal nerve – contributes towards the sensory innervation of the genitalia.Round ligament (biological females only) – originates from the uterine horn and travels through the inguinal canal to attach at the labia majora.Spermatic cord (biological males only) – contains neurovascular and reproductive structures that supply and drain the testes.The contents of the inguinal canal include: The gubernaculum then becomes two structures in the adult: the ovarian ligament and round ligament of uterus Because the ovaries are attached to the uterus by the gubernaculum, they are prevented from descending as far as the testes, instead moving into the pelvic cavity. Individuals with an XX karyotype also have a gubernaculum, which attaches the ovaries to the uterus and future labia majora. The gubernaculum (once it has shortened in the process of the descent of the testes) becomes a small scrotal ligament, tethering the testes to the scrotum and limiting their movement. The processus vaginalis normally degenerates, but a failure to do so can cause an indirect inguinal hernia, a hydrocele, or interfere with the descent of the testes. ![]() In the embryological stage, the canal is flanked by an out-pocketing of the peritoneum (processus vaginalis) and the abdominal musculature. The inguinal canal is the pathway by which the testes (in an individual with an XY karyotype) leave the abdominal cavity and enter the scrotum. A fibrous cord of tissue called the gubernaculum attaches the inferior portion of the gonad to the future scrotum or labia, and guides them during their descent. During development, the tissue that will become gonads (either testes or ovaries) establish in the posterior abdominal wall, and descend through the abdominal cavity. ![]()
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