4.Examine the internal aspect of the inguinal region, defining the deep inguinal ring, inguinal triangle, and associated structures.
In the midline note the urachus, lateral to that the obliterated umbilical artery, and most laterally, the inferior epigastric vessels, shown here. Medial to the artery, note the falx inguinalis, and below that the inguinal ligament. Between the two, the weak fascia is demonstrated by the probe. This the area where a direct inguinal hernia may occur. Medially, note that the inguinal ligament spreads out to form the lacunar ligament, a triangular ligament that leads to the pectineal ligament. Laterally, note the deep inguinal ring, here with a piece of peritoneum attached to it. Note the opening of the ring, as noted by the forceps. Now note the interior of the abdominal wall - the left side is displayed here. The forceps is grasping the inferior epigastric artery. Just lateral to it, the round ligament. Running from left to right is the inguinal ligament. Note also the lacunar ligament and the pectineal ligament in this view. Just lateral to the inferior epigastric artery is the transversalis fascia projecting into the deep inguinal ring and forming the deep ring itself. Passing through the ring is the round ligament of the uterus. Notice that it passes just lateral to the inferior epigastric vessels. Medial to the inferior epigastric vessels and between the falx inguinalis and the inguinal ligament is the area of weak fascia, the site of a direct inguinal hernia.