Hernias of the inguinal region

The inner apertures are the sites of minimal resistance. All hernias traverse an enlarged superficial inguinal ring.

These hernias can be distinguished by their rela­tions to the adjacent structures at the internal apertures.

• Indirect inguinal hernia: Lateral to the inferior epigastric artery and vein (pulsation of the artery), cranial to the inguinal ligament
• Direct inguinal hernia: Medial to the inferior epigastric artery and vein (pulsation of the artery). cranial to the inguinal ligament.
• Supravesical hernia: Medial to the obliterated umbilical artery (no pulsation). cranial to the inguinal ligament.

Inguinal hernias. if they are sufficiently large, extend into the scrotum or labium majus.

Picture of all three hernias of the inguinal region

Lacuna musculorum (= Muscular space / compartment) and Lacuna vasorum (= Vascular space / compartment)
The muscular and vascular openings establish the connection of the retroperitoneal space with the thigh. In the medial portion of the vascular compartment is the femoral canal, a weak area that serves as an aperture for a femoral hernia.

Lacuna musculorum
Borders: Inguinal ligament (ventral), Hip bone (dorsal), Iliopectineal arch (medial)
Contents: Femoral nerve, Iliopsoas muscle, Latcral femoral cutaneous nerve

Lacuna vasorum
Borders: Inguinal ligament (ventral), Pectineal ligament of Cooper (dorsal), Iliopectineal arch (lateral), Lacunar ligament of Gimbernat (medial)
Contents: Femoral artery (lateral), Femoral vein (medial), femoral branch of genitofemoral nerve
Medial to the femoral vein is the femoral canal which is occupied by loose connective tissue, the femoral septum. It contains lymphatic vessels and a proximal deep inguinal lymph node (Rosenmüller's or Cloquet's node).

• Femoral hernias

Femoral hernias course dorsal and caudal to the inguinal ligament (dorsally from inguinal hernias) and become evident inthe thigh.

Picture of two lacunae and femoral hernia