INGUINAL AREA

From Big Medical Encyclopedia

INGUINAL AREA [regio inguinalis (PNA, JNA, BNA)] — the part of a front abdominal wall limited from above to the horizontal line connecting an upper front ileal part to the outer edge of a direct muscle of a stomach, from below — an inguinal sheaf and from within — the outer edge of a direct muscle of a stomach.

Anatomy

Fig. 1. Borders of the inguinal area (Ava), inguinal triangle (CDE) and inguinal interval (F).
Fig. 2. Superficial vessels, nerves to lymph nodes of inguinal area: 1 — an aponeurosis of an outside oblique muscle of a stomach; 2 — a superficial epigastriß artery and a vein; 3 — a superficial abdominal ring; 4 — medial and 5 — lateral legs of an aponeurosis; 6 — a seed cord; 7 — an ilioinguinal nerve; 8 — an outside sexual artery and a vein; 9 — a big saphena of a leg; 10 — a lateral cutaneous nerve of a hip; 11 — superficial inguinal lymph nodes; 12 — the superficial artery and a vein which are bending around an ileal bone; 13 — an inguinal sheaf.
Fig. 3. The diagrammatic representation of inguinal area of the man (on the right — an internal oblique muscle of a stomach with the nerves located on it, at the left — a cross muscle of a stomach with the vessels and nerves located on it): 1 — a direct muscle of a stomach; 2, 4, 22, 23 — intercostal nerves; 3 — a cross muscle of a stomach; 5 and 24 — an outside oblique muscle of a stomach; 6 and 21 — an internal oblique muscle of a stomach; 7 and 20 — an iliohypogastric nerve; 8 and 19 — an ilioinguinal nerve; 9 — the deep artery which is bending around an ileal bone; 10 — a cross fascia and an internal seed fascia; 11 — a deferent duct; 12 — a mezhjyamochkovy sheaf; 13 — a pakhovy sickle; 14 — a pyramidal muscle; 15 — the medial leg of an aponeurosis (is dissected away); 16 — the bent sheaf; 17 — the muscle lifting a small egg; 18 — a sexual branch of a genitocrural nerve.

In P. lakes allocate the pakhovy triangle formed by the horizontal line going from border of an outside and average third of an inguinal sheaf to the outer edge of a direct muscle of a stomach (from above), an inguinal sheaf (from below) and the outer edge of a direct muscle of a stomach (from within). In an inguinal triangle between bottom edges of internal slanting and cross muscles of a stomach and a trench of an inguinal sheaf there is a muscular defect called by an inguinal interval (fig. 1). In the bottom internal corner of an inguinal triangle it is located pakhovy channel (see), the seed cord containing at men, and at women a round ligament of a uterus. Skin in P. of the lake thin, mobile, in it there are sweat and sebaceous glands, and also hair bulbs. Hypodermic cellulose two-layer, is penetrated by connective tissue fibers. On the site of an inguinal sheaf where these fibers are connected with a wide fascia of a hip, the inguinal fold is formed. The superficial fascia consists of two leaves, from to-rykh deep more dense and carries the name ileal and edge (tomsono-howl) a fascia. In hypodermic cellulose there pass the superficial epigastriß artery (a. epigastrica superficialis), the superficial artery which is bending around an ileal bone (a. circumflexa ilium superficialis) and an outside sexual artery (and. pudenda ext.), accompanied with the veins (fig. 2) of the same name. Limf, vessels in hypodermic cellulose form looped textures and fall into superficial inguinal nodes. P.'s skin of the lake is innervated by branches of the 12th intercostal nerve, podvzdoshnopodchrevny (n. iliohypogastricus), ilioinguinal (n. ilio inguinalis) and femoral and sexual (n. geni-tofemoralis) nerves. Own fascia covers an outside oblique muscle of a stomach and together with a deep leaf of a superficial fascia is attached to an inguinal sheaf. Side muscles of an abdominal wall — outside and internal oblique muscles of a stomach (mm. obliqui ext. et int. abdominis) and a cross muscle of a stomach (m. transversus abdominis) — are located consistently in three layers (see. Abdominal wall ). The bottom edge of an aponeurosis of m. obliqui ext. abdominis participates in formation of an inguinal sheaf and is divided into 2 legs: medial (crus med.) and lateral (crus lat.). In 10% of cases the bent sheaf meets (lig. reflexum). Medial and lateral legs, being attached to a pubic hillock and the upper edge of a symphysis, form a superficial abdominal ring, a cut it is limited outside to the arc-shaped fibers. The inguinal (pupartov) sheaf on the structure is complex education, not only three side muscles of a stomach originating from it but also a fascia of an abdominal wall and a hip take part in it. In intermuscular intervals of side muscles of a stomach there are fascial leaves, friable cellulose and there pass branches of the 12th intercostal nerve, iliohypogastric and ilioinguinal nerves. From internal slanting and cross (in 25% of cases) muscles the muscle fibers forming the muscle lifting a small egg (m. cremaster) separate. The cross muscle of a stomach on the site of an inguinal interval has the arc-shaped course of muscle fibers, forming an inguinal arch over an inguinal sheaf. Distinguish 2 forms of an inguinal interval: slit-like and oval and triangular. At an inguinal sheaf the cross muscle covers a deep ring of the inguinal channel, then passes into a tendinous aponeurosis, being thrown through a seed cord, and comes to an end at a pubic hillock, being interwoven into a lacunary sheaf and forming a pakhovy sickle (falx inguinalis). Sometimes the integrated sinew of internal slanting and cross muscles of a stomach meets. From the lateral party the pakhovy interval is strengthened by a mezhjya-mochkovy sheaf (lig. interfoveola-ga). Deep layers of P. of the lake: cross fascia, preperitoneal cellulose and peritoneum. The cross fascia (fascia transversalis) at an inguinal sheaf has more dense structure, forming a strip 1 cm wide (ileal and pubic tyazh). Outside part of a cross fascia is spliced with an inguinal sheaf, and internal — with pubic (kuperovsky). Preperitoneal cellulose represents a layer of friable connecting fabric. The parietal peritoneum forms in P. the lake a number of folds and poles (see. Abdominal wall ). The seed cord is accompanied: kremasterny arteries and veins (vasa cremasterica), yaichkovy artery and veins (vasa testicularia), artery and veins of a deferent duct (and. et v. ductus deferentis) (fig. 3). In interfascial kletchatochny space, then in retroperitoneal cellulose there pass the deep arteries and veins which are bending around an ileal bone (vasa circumflexa ilii profunda) to-rye go along an inguinal sheaf.

Pathology

From congenital anomalies and the acquired defects of a structure of P. of the lake most often meet hernias (see).

From inflammatory processes are quite often observed furuncle (see), anthrax (see), hydradenitis (see), lymphadenitis superficial limf, nodes (see. Lymphadenitis ), developing owing to transmission of infection from the inflammatory centers, the localized hl. obr. on skin of external genitals and the anteromedial surface of a hip, sometimes shins and feet. Specific pakhovy lymphadenitis at primary is characteristic syphilis (see) and soft chancre (see). At a venereal ulcer often there is a purulent fusion limf, nodes to formation of a typical ulcer in a groin. In P. of the lake the cold congestive abscesses arising at tubercular sometimes go down spondylitis (see).

Operations

P. the lake is of great interest in surgery from the point of view of the choice of the safest quick accesses to the ileal blood vessels, abscesses and phlegmons located in subperitoneal department of a small pelvis (see. Pirogova section ). Besides, through P. the lake provide quick accesses to contents inguinal channel (see) at inguinal hernias (see) and at the funikulotsel (see. Seed cord ).



Bibliography: Venglovsky R. I. About sinking of a small egg, in book: Works of state pitas. hir. clinics, under the editorship of P. I. Dyakonov, t. 1, page 7, M., 1903; it, Development and «structure of inguinal area, their relation to an etiology of inguinal hernias, M., 1903; 3 about-lotareva T. V. Surgical anatomy of a front sidewall of a stomach, in book: Hir. annate, a stomach, under the editorship of. A. N. Maksimenkova, page 23, JI., 1972; To at-kudzhanov N. I. Inguinal hernias, M., 1969; JI at about c to and y D. N. Fundamentals of topographical anatomy, page 458, M., 1953; Ostroverkhov G. E, JI at about the Central Committee and y D. N. and B about m and sh Yu. M. Operational surgery and topographical anatomy, M., 1972.


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

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