Anatomy clinical correlates: Inguinal region

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A 15-year-old boy is brought to the emergency department because of severe abdominal pain, nausea, and vomiting. A few hours ago, he was playing basketball with his friends when he first developed mild abdominal pain. The pain increased gradually, and since then, the patient had increasing nausea and three episodes of vomiting. The patient has had similar, milder episodes in the past that resolved with rest. The review of systems is otherwise unremarkable. Past medical history is noncontributory. He is sexually active and uses condoms consistently. Temperature is 37.7°C (99.9°F), pulse is 95/min, respirations are 18/min, and blood pressure is 100/60 mmHg. Physical examination shows a soft, nontender, and nondistended abdomen. There is marked swelling, erythema, and tenderness of the right hemiscrotum. The pain is worsened when the right testis is elevated, and the scrotum does not transilluminate. Cremasteric reflex is absent on the right side. Physical examination of the left hemiscrotum and testis is unremarkable. Urinalysis is unremarkable. Which of the following is the most likely cause of this patient’s condition?

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The inguinal region, located near the groin, is found in the lower part of the anterior abdominal wall, and it contains several important structures that enter and leave the abdomen. Understanding the anatomy of the inguinal region is important for understanding common clinical conditions such as hernias, and many others!

Speaking of which, hernias occur when an organ or tissue protrudes through the wall of the muscle or tissue that normally contains it. The majority of hernias occur in the abdominal cavity or the inguinal region, through which subcutaneous fat, abdominal omental fat, or even abdominal viscera can protrude. In order for a hernia to happen, there is typically a weak point along the abdominal wall, such as a weak linea alba, previous surgical interventions that weaken the abdominal wall muscles, or pregnancy.

First, let’s look at anterior abdominal wall hernias. They can be divided into 4 categories: epigastric, umbilical or periumbilical, spigelian and incisional hernias. Epigastric hernias are caused by a weakened linea alba and are basically defects in the abdominal midline between the umbilicus and the xiphoid process. Then, there are umbilical or paraumbilical hernias, which are hernias through the umbilical ring or around the umbilicus. These are often found in children, because the umbilical ring is weak at birth, but can also be acquired in adults and frequently affect pregnant or obese individuals.

Spigelian hernias are found along the semilunar lines which are skin folds from the inferior costal margin of the 9th costal cartilage to the pubic tubercles and overly the tendinous insertions of the rectus abdominis muscle, as abdominal tissue can protrude through these areas of tendinous insertions. Finally, an incisional hernia can develop at the site of a prior surgical incision as the muscle and fascia is typically weakened, for example over the surgical site for an appendectomy.

Sources

  1. "Groin Hernias in Adults" New England Journal of Medicine (2015)
  2. "The diagnosis and management of hiatus hernia" BMJ (2014)
  3. "Cryptorchidism and Testicular Cancer: Separating Fact From Fiction" Journal of Urology (2009)
  4. "Varicocele as a source of male infertility – current treatment techniques" Central European Journal of Urology (2015)
  5. "Common Scrotal and Testicular Problems" Primary Care: Clinics in Office Practice (2010)
  6. "Essentials of Abdominal Wall Hernias" I. K. International Pvt Ltd (2009)
  7. "Essentials of Abdominal Wall Hernias" I. K. International Pvt Ltd (2009)
  8. "Essential Practice of Surgery" Springer Science & Business Media (2003)
  9. "Diseases of the Human Body" F A Davis Company (2010)
  10. "Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review" Physiotherapy (2014)
  11. "Management and treatment of varicocele in children and adolescents: an endocrinologic perspective" J Clin Med (2019)
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