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Anatomy

Abdomen

Question 147 of 180

Which of the following structures does NOT pass through the inguinal canal:

Answer:

The inferior epigastric artery does not pass through the inguinal canal. The inguinal canal contains:
  • the genital branch of the genitofemoral nerve (within the spermatic cord in men)
  • the spermatic cord in men
  • the round ligament in women
  • the ilioinguinal nerve (passes through part of the canal, exiting the superficial inguinal ring with the other contents)

Inguinal Canal

The inguinal canal is a slit-like passage that extends in a downwards and medial direction, just above and parallel to the lower half of the inguinal ligament. It begins at the deep inguinal ring and continues for approximately 4 cm, ending at the superficial inguinal ring.

Table: Anatomical Boundaries and Contents of the Inguinal Canal

Inguinal Canal Anatomy
Position Between deep and superficial inguinal rings, just above and parallel to lower half of inguinal ligament
Anterior wall Formed by external oblique aponeurosis (reinforced by internal oblique muscle laterally)
Posterior wall Formed by transversalis fascia (reinforced by conjoint tendon medially)
Roof Formed by transversus abdominis and internal oblique muscles
Floor Formed by medial one-half of inguinal ligament (reinforced by lacunar ligament medially)
Deep inguinal ring Opening in transversalis fascia, located just superior to mid-inguinal point (midway between ASIS and pubic symphysis)
Superficial inguinal ring Opening in external oblique aponeurosis, located just superior to pubic tubercle
Contents Genital branch of genitofemoral nerve, spermatic cord, round ligament, ilioinguinal nerve

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Inguinal Canal. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Roof, walls and floor

The anterior wall of the inguinal canal is formed along its entire length by the aponeurosis of the external oblique muscle, and reinforced by the internal oblique muscle laterally.

The posterior wall of the inguinal canal is formed along its entire length by the transversalis fascia and reinforced by the conjoint tendon medially.

The roof of the inguinal canal is formed by arching fibres of the transversus abdominis and internal oblique muscles.

The floor of the inguinal canal is formed by the medial one-half of the inguinal ligament, reinforced medially by the lacunar ligament.

Deep inguinal ring

The deep inguinal ring, the opening in the transversalis fascia, is the beginning of the inguinal canal.

The surface marking of the deep inguinal ring is commonly described as being located at either:

  • the midpoint of the inguinal ligament (midway between the anterior superior iliac spine and the pubic tubercle)
  • the mid‐inguinal point (midway between the anterior superior iliac spine and the pubic symphysis)

It lies just above the inguinal ligament and immediately lateral to the inferior epigastric vessels; the femoral artery can be palpated in the same position but below the inguinal ligament.

Superficial inguinal ring

The superficial inguinal ring is the end of the inguinal canal.

The superficial inguinal ring is located just superior to the pubic tubercle. It is a triangular opening in the aponeurosis of the external oblique, with its apex pointing superolaterally and its base formed by the pubic crest.

 Contents

The inguinal canal contains:

  • the genital branch of the genitofemoral nerve (within the spermatic cord in men)
  • the spermatic cord in men
  • the round ligament in women
  • the ilioinguinal nerve (passes through part of the canal, exiting the superficial inguinal ring with the other contents)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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