The pediatric inguinal canal: Systematic review of the embryology and surface anatomy

Abstract

The inguinoscrotal region is one of the most common areas operated on in pediatric surgery. Despite this, the surface anatomy of the pediatric inguinal canal is variably defined. The aim of the current systematic review is to evaluate the development and surface anatomy of the pediatric inguinal canal. A systematic review of inguinal canal anatomy in children was conducted using the electronic databases: Medline, PubMed, Scopus, and Google Scholar. Relevant anatomical measurements and relationships were reviewed. The anatomical structures forming the walls of the inguinal canal were identified in fetuses as early as 8-10 weeks gestation. No studies addressed the developmental basis of this early defect in the lower anterior abdominal. Later gonadal development and descent has a defined role. In vivo measurements of children carried out during open surgery are inconsistent. Some studies showed rapid growth velocity of the length of the inguinal canal up to 2 years of age (with height and growth of the bony pelvis) before plateauing, while others suggested no increase in canal length prior to 10 years of age. The position of the deep inguinal ring was equally unclear; some studies suggested this was medial to the midpoint of the inguinal ligament. No studies described the position of the superficial ring, challenging the assumption that the rings are superimposed in the neonate. The dearth of studies analyzing pediatric inguinal anatomy means that changes in the position of the rings with respect to the lengthening of the canal remain unclear.

Labial Mass in an Irritable 35-Day-Old Female

“…1,2 Known risk factors include the male sex, prematurity, cystic fibrosis, constipation, and vigorous crying. 1,7 The patent processus vaginalis is commonly referred to as the canal of Nuck in females. If present, signs and symptoms include a bulge in the groin or labia majora, erythema, localized pain, increased irritability, crying, and vomiting.…”

“…The inferior gubernaculum will become the round ligament, attaching to the uterus, extending through the inguinal canal and insert into the labia majora. 7 The processus vaginalis normally obliterates, leaving the deep inguinal canal, which in females contains the round ligament, the genital branch of the genitofemoral nerve, and the ilioinguinal nerve traveling in it. Simultaneously, fascia around the processus vaginalis and gubernaculum develops to form the deep inguinal ring.…”

Age‐related changes in inguinal region anatomy from 0 to 19 years of age

“…The inguinal region is one of the most commonly accessed by pediatric surgeons and urologists to treat conditions such as indirect inguinal hernia, congenital hydrocele, and cryptorchidism (Singal and Shukla ; Osuoji and Bankole ; Taghavi et al ). The incidence of these congenital abnormalities is particularly high in babies who are premature, therefore this group is more likely to require surgery (Davenport ; Singal and Shukla ; Williamson et al ).…”

“…The adult inguinal canal is an oblique inferomedially oriented passageway through the inferomedial part of the anterior abdominal wall through which a range of structure pass; including the spermatic cord in males and the round ligament of the uterus in females (Standring ). It is accessed by the deep (located internally) and superficial (located externally) inguinal rings and has a length of 3–6 cm in the adult (Osuoji and Bankole ; Standring ; Taghavi et al ). The deep inguinal ring in adults is commonly located in the region between the midpoint of the inguinal ligament and a point midway between the anterior superior iliac spine and the pubic symphysis (midinguinal point) (Campbell ; Andrews et al ; Parnis et al ; Koliyadan et al ; Hale et al ; Tunstall and Shah ).…”

“…Growth of the pelvis, abdominal wall, and inguinal canal is thought to be progressive throughout infancy and into adolescence. Knowledge of important anatomical landmarks in the inguinal region and how their position changes during development is essential, so that surgical access sites can be adjusted to minimize the risk of damage to the spermatic cord and its contents, and to the ilioinguinal nerve (Taghavi et al ).…”