Page 12 - herina surgery and possible lawsuits

3) External oblique muscle and aponeurosis- it is flat muscle which arises from
the external surface of 5th - 12th nbs. Then it takes an oblique course downwards
and medially. It inserts m linea alba, pubic tubercle and anterior half of iliac crest.

It is muscular in the superior and lateral parts but becomes aponeurotic m its lower
and medial parts.

a) Superficial inguinal ring- it is a triangular aperture in the external oblique
aponeurosis immediately superomedially to the pubic tubercle and lies
obliquely with a medial crus and a lateral crus. The spermatic cord (or the
round ligament of uterus) passes through it and carries the external

spermatic fascia (or the external covermg of the round ligament of the
uterus) from the margins of the ring.

b) Inguinal Ligament- It is a thick in rolled inferior border of the external
oblique aponeurosis with a grooved abdominal surface and it stretches
from the anterior superior iliac spine to the pubic tubercle and its

convexity towards the thigh. From the medial part of the inguinal ligament
arises the lacunar ligament and extends backwards and upwards to the
pectenial Ime on the superior ramus of pubis. On reaching the pectemal

line it becomes continuous with the thickening of the periosteum called the
pectenial ligament (Cooper’s ligament).
c) Reflected part of the inguinal ligament- It is an expansion from the lateral

crus of the superficial ring and ascends medially and behind the superficial
ring behind the external oblique aponeurosis and m front of the conjoint
tendon.

4) Internal oblique muscle and aponeurosis- It is the middle layer of the
abdominal wall muscles. It arises from the thoracolumbar fascia, anterior two-
thirds of the intermediate area of the iliac crest and lateral two-thirds of the

inguinal ligament. It runs upwards and medially almost perpendicular to the
external oblique. Insertion is to the 10th ~ 12th (lower three) nbs, the xiphoid
process, the linea alba and the symphysis pubis. It is lower free border along with

the transversus abdominis fibers arches over the spermatic cord and is called the
conjoint tendon. As the spermatic cord (or the round ligament of uterus) passes
under its free border some of its fibers cover it to form the spermatic muscle.

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