[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) › Inguinal canal [Muscular system](https://durgical.com/en/anatomy/system/muscular-system/) · [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) # Inguinal canal The inguinal canal is a short passage through the lower belly wall in the groin; it carries the spermatic cord or round ligament, and groin hernias occur here. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=abdomen&select=inguinal_canal&side=r) Opens in the Durgical app, no sign-up needed. ## What it is A short tunnel (about 4 cm) through the lower abdominal wall, above the inguinal ligament, from the deep ring to the superficial ring. ## What it does Carries the spermatic cord in men (the round ligament in women). Because it crosses the wall, it is a weak spot. ## Key points - The inferior epigastric vessels divide groin hernias: indirect ones enter the deep ring lateral to them; direct ones push through Hesselbach triangle medial to them - Hesselbach triangle: inferior epigastric vessels (lateral), lateral border of the [rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/) (medial), inguinal ligament (below) - Inguinal hernias appear above and medial to the pubic tubercle; femoral hernias below and lateral to it, under the inguinal ligament - The ilioinguinal nerve runs in the canal but outside the spermatic cord, and leaves through the superficial ring ## Key facts **Where** Oblique tunnel about 4 cm long, just above medial half of inguinal ligament; deep ring above its midpoint, superficial ring above pubic tubercle **Attaches** Front: external oblique aponeurosis; back: transversalis fascia (+ conjoint tendon medially); roof: internal oblique and transversus; floor: inguinal ligament **Function** Transmits spermatic cord (male) or [round ligament of uterus](https://durgical.com/en/anatomy/round-ligament-of-uterus/) (female) and the ilioinguinal nerve; indirect hernias enter at deep ring ## Relations **In front** [External oblique](https://durgical.com/en/anatomy/external-abdominal-oblique-muscle/) aponeurosis along the whole canal, reinforced in its lateral third by the lowest fibres of the [internal oblique](https://durgical.com/en/anatomy/internal-abdominal-oblique-muscle/) **Behind** [Transversalis fascia](https://durgical.com/en/anatomy/transversalis-fascia/) along the whole canal, reinforced medially by the conjoint tendon; the inferior [epigastric vessels](https://durgical.com/en/anatomy/inferior-epigastric-artery/) lie just medial to the deep ring **Above** Roof: the arching lower fibres of internal oblique and [transversus abdominis](https://durgical.com/en/anatomy/transversus-abdominis-muscle/) **Below** Floor: the in-rolled [inguinal ligament](https://durgical.com/en/anatomy/inguinal-ligament/), with the lacunar ligament medially **Contents** [Spermatic cord](https://durgical.com/en/anatomy/spermatic-cord/) ([ductus deferens](https://durgical.com/en/anatomy/ductus-deferens/), [testicular artery](https://durgical.com/en/anatomy/testicular-artery-pelvis/), pampiniform plexus, cremasteric vessels, genital branch of the [genitofemoral nerve](https://durgical.com/en/anatomy/genitofemoral-nerve/), lymphatics) or the round ligament of the uterus; plus the ilioinguinal nerve. Deep ring: an opening in transversalis fascia; superficial ring: a split in the external oblique aponeurosis ## How to find it The deep ring lies just above the midpoint of the inguinal ligament (halfway between the anterior superior iliac [spine](https://durgical.com/en/anatomy/region/spine/) and the pubic tubercle); the superficial ring lies just above and lateral to the pubic tubercle. In a standing man, the examiner's little finger can follow the loose scrotal [skin](https://durgical.com/en/anatomy/skin/) up to the superficial ring and feel for an impulse when the person coughs. ## Examination - Cough impulse: an expansile bulge in the groin swelling on coughing indicates a hernia rather than a lymph node or lipoma - Deep ring occlusion test: with the hernia reduced and pressure over the deep ring, a hernia held back on coughing suggests indirect; one bulging medial to the finger suggests direct. Not reliable on its own - Getting above the swelling: a scrotal swelling the examiner can't get above extends from the canal (inguinoscrotal hernia); one the examiner can get above is a scrotal lesion - Position relative to the pubic tubercle separates inguinal (above and medial) from femoral (below and lateral) hernias ## On imaging Dynamic ultrasound with coughing or straining shows the hernia sac and its relation to the inferior epigastric vessels: lateral means indirect, medial means direct. CT or MRI helps when the examination is unclear. ## Common problems - Indirect inguinal hernia: bowel or fat goes through the deep ring along the cord; the most common type, at any age. - Direct inguinal hernia: the floor of the canal weakens, usually in older men. - A hernia that gets stuck (incarcerated) and loses its blood supply (strangulated) is an emergency. ## How it is diagnosed A bulge in the groin that grows when coughing or standing; ultrasound if unclear. ## Treatment - Repair with a mesh, open or laparoscopic. ## Clinical notes - Indirect hernia follows a patent processus vaginalis; it is the most common groin hernia in both sexes and in children, more often on the right - Direct hernia: a broad bulge through a weak posterior wall in older men; its wide neck makes strangulation less likely - Femoral hernia passes through the femoral canal below the inguinal ligament; more common in women and, with its narrow neck, prone to strangulation - Open repair can injure or trap the ilioinguinal, iliohypogastric or genital branch of the genitofemoral nerve, causing chronic groin pain or numbness of the groin and [scrotum](https://durgical.com/en/anatomy/scrotum/) or labium - In a woman the canal carries the round ligament; a canal of Nuck cyst or hernia is the female counterpart of a patent processus vaginalis ## Development The gubernaculum guides the [testis](https://durgical.com/en/anatomy/testis/) from the posterior abdominal wall through the canal, which it usually completes by birth, pushing a peritoneal pouch (processus vaginalis) ahead of it. If the pouch fails to close, an indirect hernia or a hydrocele can follow. ## Memory aid English mnemonic MALT, going round the canal from the roof: Muscles (internal oblique, transversus) roof; Aponeuroses (external and internal oblique) front; Ligaments (inguinal, lacunar) floor; Tendon and Transversalis fascia (conjoint tendon) back. ## Related conditions - [Inguinal hernia](https://durgical.com/en/conditions/inguinal-hernia/) - [Androgen insensitivity syndrome](https://durgical.com/en/conditions/androgen-insensitivity-syndrome/) ## Test yourself Think of the answer, then tap the question to see it. ## What landmark separates direct from indirect inguinal hernias? The inferior epigastric vessels: indirect hernias enter the deep ring lateral to them; direct hernias push through Hesselbach triangle medial to them. ## What are the boundaries of Hesselbach triangle? Inferior epigastric vessels laterally, the lateral border of the rectus abdominis medially and the inguinal ligament below. ## What forms the walls of the inguinal canal? Front: external oblique aponeurosis; back: transversalis fascia (plus conjoint tendon medially); roof: internal oblique and transversus; floor: inguinal ligament. ## Which nerve runs in the inguinal canal outside the spermatic cord? The ilioinguinal nerve, which leaves through the superficial ring; it can be injured or trapped in open repair, causing chronic groin pain or numbness. ## How do inguinal and femoral hernias relate to the pubic tubercle? Inguinal hernias appear above and medial to the pubic tubercle; femoral hernias below and lateral to it, under the inguinal ligament. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/anatomy/inguinal-canal/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** canalis inguinalis; anulus inguinalis profundus; anulus inguinalis superficialis TA2 2381 **Official Spanish (DeCS)** Conducto inguinal DeCS D007264 **English (TA2)** Inguinal canal **Also called** internal inguinal ring · external inguinal ring ## Related - [Spermatic cord](https://durgical.com/en/anatomy/spermatic-cord/) - [Inguinal ligament](https://durgical.com/en/anatomy/inguinal-ligament/) - [Epigastric vessels](https://durgical.com/en/anatomy/inferior-epigastric-artery/) - [Iliohypogastric and ilioinguinal nerves](https://durgical.com/en/anatomy/iliohypogastric-nerve/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=7439&filter=ths_termall&q=Conducto%20Inguinal); [Anatomy, Abdomen and Pelvis: Inguinal Region (Inguinal Canal)](https://www.ncbi.nlm.nih.gov/books/NBK470204/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/inguinal-canal/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/inguinal-canal/