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The inguinal canal is an oblique passage through the
lower part of the anterior abdominal wall.
Dr M Idris Siddiqui
 Allow contents of the scrotum to
communicate with intra-abdominal contents
 Prevent mobile intra-abdominal contents
(e....
4
Anterior wall
Roof
Floor
Imagine the right side inguinal canal viewed from the front as a
box with anterior & posterior ...
5
Posterior wall
Floor
Here are the posterior wall, which has the DEEP inguinal ring
situated laterally, and the floor. (R...
6
Posterior wall
Floor
Here are the anterior wall (which has the SUPERFICIAL
inguinal ring situated medially), and the roo...
7
Posterior wall
Floor
Spermatic cord
exits through
the superficial
inguinal ring
Anterior wall
Spermatic cord enters the
...
8
Anterior wall
Superficial inguinal ring
The anterior wall is made up of the external
oblique muscle throughout, and is r...
9
Posterior wall
Floor
Spermatic cord
Anterior wall
The transversus abdominis and internal
oblique mm. combine to form the...
10
Deep inguinal ring
The posterior wall is formed by transversalis fascia (orange)
throughout and the conjoint tendon (re...
11
FloorThe floor is formed by an incurving of the inguinal ligament, which
is part of the external oblique muscle, formin...
12
The anterior wall of the canal is formed by external oblique muscle
(orange) throughout and by internal oblique muscles...
• A horizontal line
stretching from
anterior iliac spine to
lateral margin of
rectus abdominis.
• The inguinal canal is
la...
In the males, it allows structures to pass
to and from the testis to the abdomen.
In females it allows the round ligamen...
 The canal is about 1.5 in. (4 cm) long in the adult.
 It is directed inferomedially through the inferior
part of the an...
 It extends from the deep inguinal ring, a hole in
the fascia transversalis , downward and medially
to the superficial in...
 It is an oval opening in the fascia transversalis, lies
about 0.5 in. (1.3 cm) above the inguinal ligament
midway betwee...
It is a triangular-shaped defect in the
aponeurosis of the external oblique
muscle and lies immediately above and
medial ...
 Anterior
 Posterior
 Superior
 Inferior
 Anterior wall:
 External oblique aponeurosis, reinforced laterally by the origin of the internal
oblique from the ingui...
1- Spermatic cord in male or round
ligament of uterus in female.
2- Genital branch of genitofemoral
nerve (to cremasteric ...
1- Spermatic cord or round ligament
of uterus.
2- Internal spermatic fascia.
3- Cremasteric muscle & its fascia.
4- Genita...
The inguinal ligament is the thickened,
underturned, inferior margin of the
aponeurosis of the external oblique
 It form...
The inguinal ligament and iliopubic tract,
extending from the ASIS to the pubic tubercle,
constitute a bilaminar anterior...
 The inguinal canal allows structures of the
spermatic cord to pass to and from the testis to the
abdomen in the male.
 ...
Medially ® lat. border of
rectus sheath.
Laterally ®inf. epigastric
artery.
Inferiorly ® inguinal
ligament..
Floor (post.)...
 The posterior wall of the canal is particularly
weak laterally because of the deep inguinal ring
 The anterior wall opp...
 The anterior wall of the canal is weak medially
where the superficial inguinal ring is situated
 The posterior wall, op...
37
Deep inguinal ring ↑ intra –abdominal
pressure
Spermatic cord
Superficial inguinal ring
Conjoint tendon
= areas where r...
38
Deep inguinal ring ↑ intra –abdominal
pressure
Superficial inguinal ring
Conjoint tendon
Reinforced
anterior
wall
Reinf...
 Pass through the deep ring
 Travel along the canal
 Exit the superficial ring above and medial to the
pubic tubercle (...
 Peritoneum
 Internal spermatic fascia
(from transversalis fascia)
 Cremaster muscle & fascia
(from transversus abdomin...
 If the posterior wall of the canal is weakened
medially (e.g. by chronically increased intra-
abdominal pressure), it ca...
 Peritoneum
 Transversalis fascia
 Conjoint tendon
 External oblique aponeurosis
 Superficial fascia
 Skin
42
This i...
 A potential weakness
 A design to lessen weakness:
 Oblique passage weakest areas lying some→
distance apart
 Anterio...
On coughing/straining
(defecation, parturition etc.) →
Internal oblique and transversus
abdominis muscles contract →
flat...
 The inguinal ligamen spans the subinguinal
space, through which pass flexors of the hip
and the neurovascular structures...
 The inferior epigastric vessels are important posterior
relations of the medial end of the canal. They lie on the
transv...
 Pectineal
(backward)extension of
inguinal ligament to
pectineal line (pectin pubis)
 Pectineal ligament is lateral
exte...
 The lacunar ligament is a thick triangular band of tissue
lying mainly posterior to the medial end of the inguinal
ligam...
Inconstant
Thin triangular band which
passes upwards & medially
from medial part of inguinal
ligament
 INGUINAL HERNIA: An inguinal hernia involves the
protrusion of a viscus through the tissues of the
inguinal region of th...
 Femoral hernia:A femoral hernia protrudes
through the femoral ring. The femoral ring is
normally closed by a femoral sep...
 The interfoveolar ligament is a thickening of
the transversalis fascia at the medial side of
the internal inguinal ring....
 Inconstant
 Thin triangular band which passes upwards &
medially from medial part of inguinal ligament
(from the pubic ...
 If the funicular process is unobliterated in the female a
small diverticulum from the peritoneum(canal of Nuck)
accompan...
The gut tube can herniate into the path of the testis.
Inguinal hernias breach the weakness of the abdominal wall around t...
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Inguinal canal

  1. 1. The inguinal canal is an oblique passage through the lower part of the anterior abdominal wall. Dr M Idris Siddiqui
  2. 2.  Allow contents of the scrotum to communicate with intra-abdominal contents  Prevent mobile intra-abdominal contents (e.g. intestine) from entering the scrotum and possibly becoming damaged, while at the same time permitting blood vessels, nerves, lymphatics, vas deferens etc. to supply the scrotal contents 3 Dr C Slater, Department of Human Biology, University of Cape Town
  3. 3. 4 Anterior wall Roof Floor Imagine the right side inguinal canal viewed from the front as a box with anterior & posterior walls, a roof & floor. The arrow indicates that structures can run through it from lateral to medial – e.g. in males it transmits the spermatic cord, and in females, the round ligament of the uterus. Dr C Slater, Department of Human Biology, University of Cape Town Posterior wall
  4. 4. 5 Posterior wall Floor Here are the posterior wall, which has the DEEP inguinal ring situated laterally, and the floor. (Roof and anterior wall removed). Deep inguinal ring Dr C Slater, Department of Human Biology, University of Cape Town
  5. 5. 6 Posterior wall Floor Here are the anterior wall (which has the SUPERFICIAL inguinal ring situated medially), and the roof. Anterior wall Roof Superficial inguinal ring Dr C Slater, Department of Human Biology, University of Cape Town
  6. 6. 7 Posterior wall Floor Spermatic cord exits through the superficial inguinal ring Anterior wall Spermatic cord enters the inguinal canal through the deep inguinal ringDeep inguinal ring Superficial inguinal ring Dr C Slater, Department of Human Biology, University of Cape Town
  7. 7. 8 Anterior wall Superficial inguinal ring The anterior wall is made up of the external oblique muscle throughout, and is reinforced by the internal oblique m. laterally. The transversus abdominus m. lies even more laterally as part of the anterior abdominal wall. The anterior wall is made up of the external oblique muscle throughout, and is reinforced by the internal oblique m. laterally. The transversus abdominus m. lies even more laterally as part of the anterior abdominal wall. Dr C Slater, Department of Human Biology, University of Cape Town
  8. 8. 9 Posterior wall Floor Spermatic cord Anterior wall The transversus abdominis and internal oblique mm. combine to form the CONJOINT tendon that arches over the contents of the inguinal canal The transversus abdominis and internal oblique mm. combine to form the CONJOINT tendon that arches over the contents of the inguinal canal The conjoint tendon attaches to the pubic crest, reinforces the posterior canal wall medially and also forms the ROOF of the canal The conjoint tendon attaches to the pubic crest, reinforces the posterior canal wall medially and also forms the ROOF of the canal Dr C Slater, Department of Human Biology, University of Cape Town Conjoint tendon
  9. 9. 10 Deep inguinal ring The posterior wall is formed by transversalis fascia (orange) throughout and the conjoint tendon (red) medially. The wall is particularly weak over the deep inguinal ring Conjoint tendon medially Dr C Slater, Department of Human Biology, University of Cape Town Posterior wall
  10. 10. 11 FloorThe floor is formed by an incurving of the inguinal ligament, which is part of the external oblique muscle, forming a gutter. (Medially it forms the lacunar ligament which is not illustrated). Dr C Slater, Department of Human Biology, University of Cape Town
  11. 11. 12 The anterior wall of the canal is formed by external oblique muscle (orange) throughout and by internal oblique muscles (red/black/white) laterally. This wall is weak medially because of the “hole” in the external oblique muscle (= superficial inguinal ring). The anterior wall of the canal is formed by external oblique muscle (orange) throughout and by internal oblique muscles (red/black/white) laterally. This wall is weak medially because of the “hole” in the external oblique muscle (= superficial inguinal ring). Anterior wall Roof is formed by the conjoint tendon and the meeting of the anterior and posterior walls of the canal Superficial inguinal ring Dr C Slater, Department of Human Biology, University of Cape Town
  12. 12. • A horizontal line stretching from anterior iliac spine to lateral margin of rectus abdominis. • The inguinal canal is larger and more prominent in men.
  13. 13. In the males, it allows structures to pass to and from the testis to the abdomen. In females it allows the round ligament of the uterus to pass from the uterus to the labium majus.  The inguinal canal also contains blood and lymphatic vessels and the ilioinguinal nerve in both sexes.
  14. 14.  The canal is about 1.5 in. (4 cm) long in the adult.  It is directed inferomedially through the inferior part of the anterolateral abdominal wall.  It lies parallel and superior to the medial half of the inguinal ligament.  Its size and form vary with age, and although it is present in both sexes it is most well developed in the male.
  15. 15.  It extends from the deep inguinal ring, a hole in the fascia transversalis , downward and medially to the superficial inguinal ring, a hole in the aponeurosis of the external oblique muscle.  It lies parallel to and immediately above the inguinal ligament.  In the newborn child, the deep ring lies almost directly posterior to the superficial ring so that the canal is considerably shorter at this age. Later, as the result of growth, the deep ring moves laterally.
  16. 16.  It is an oval opening in the fascia transversalis, lies about 0.5 in. (1.3 cm) above the inguinal ligament midway between the anterior superior iliac spine and the symphysis pubis.  KLM: located superior to the middle of the inguinal ligament and lateral to the inferior epigastric artery.  Gray’s: Situated midway between the anterior superior iliac spine and the symphysis pubis c.1.25 cm above the inguinal ligament.  Related to it medially are the inferior epigastric vessels, which pass upward from the external iliac vessels.  The margins of the ring give attachment to the internal spermatic fascia (or the internal covering of the round ligament of the uterus).
  17. 17. It is a triangular-shaped defect in the aponeurosis of the external oblique muscle and lies immediately above and medial to the pubic tubercle. The margins of the ring, sometimes called the crura, give attachment to the external spermatic fascia.
  18. 18.  Anterior  Posterior  Superior  Inferior
  19. 19.  Anterior wall:  External oblique aponeurosis, reinforced laterally by the origin of the internal oblique from the inguinal ligament.  This wall is therefore strongest where it lies opposite the weakest part of the posterior wall, namely, the deep inguinal ring.  Posterior wall:  Conjoint tendon medially, fascia transversalis laterally.  This wall is therefore strongest where it lies opposite the weakest part of the anterior wall, namely, the superficial inguinal ring.  Roof or superior wall:  Arching lowest fibers of the internal oblique and transversus abdominis muscles  Floor or inferior wall:  Upturned lower edge of the inguinal ligament and, at its medial end, the lacunar ligament.
  20. 20. 1- Spermatic cord in male or round ligament of uterus in female. 2- Genital branch of genitofemoral nerve (to cremasteric muscle) 3- Cremasteric artery which is branch of inferior epigastric artery to cremasteric muscle.
  21. 21. 1- Spermatic cord or round ligament of uterus. 2- Internal spermatic fascia. 3- Cremasteric muscle & its fascia. 4- Genital branch of genitofemoral nerve. 5- Cremasteric artery. 6- Ilio-inguinal nerve.
  22. 22. The inguinal ligament is the thickened, underturned, inferior margin of the aponeurosis of the external oblique  It forms a retinaculum that bridges the subinguinal space. A slit-like gap between the medial and the lateral crura of the external oblique aponeurosis, bridged by intercrural fibers, forms the superficial inguinal ring
  23. 23. The inguinal ligament and iliopubic tract, extending from the ASIS to the pubic tubercle, constitute a bilaminar anterior (flexor) retinaculum of the hip joint  The iliopubic tract is the thickened inferior margin of the transversalis fascia, which appears as a fibrous band running parallel and posterior (deep) to the inguinal ligament The iliopubic tract is a useful landmark during laparoscopic hernia repair .  The retinaculum spans the subinguinal space, through which pass flexors of the hip and the neurovascular structures serving much of the lower limb Inguinal ligament
  24. 24.  The inguinal canal allows structures of the spermatic cord to pass to and from the testis to the abdomen in the male.  (Normal spermatogenesis takes place only if the testis leaves the abdominal cavity to enter a cooler environment in the scrotum.)  In the female, the smaller canal permits the passage of the round ligament of the uterus from the uterus to the labium majus.
  25. 25. Medially ® lat. border of rectus sheath. Laterally ®inf. epigastric artery. Inferiorly ® inguinal ligament.. Floor (post.) ® conjoint tendon & fascia transversalis.
  26. 26.  The posterior wall of the canal is particularly weak laterally because of the deep inguinal ring  The anterior wall opposite the deep ring is reinforced laterally by the internal oblique m.  A hernia (e.g. of small bowel) that comes through the deep inguinal ring will have to travel along the inguinal canal as it cannot push into the reinforced layers of muscle in the anterior wall of the canal directly opposite the deep inguinal ring 35 Dr C Slater, Department of Human Biology, University of Cape Town
  27. 27.  The anterior wall of the canal is weak medially where the superficial inguinal ring is situated  The posterior wall, opposite the superficial ring, is reinforced medially by the conjoint tendon that is formed by fibres of the internal oblique and transversus abdominis muscles  Abdominal contents cannot normally force themselves through the superficial ring directly because of the reinforced posterior wall medially 36 Dr C Slater, Department of Human Biology, University of Cape Town
  28. 28. 37 Deep inguinal ring ↑ intra –abdominal pressure Spermatic cord Superficial inguinal ring Conjoint tendon = areas where reinforcement is present Reinforced anterior wall by internal oblique m. Reinforced posterior wall Pressure on anterior wall
  29. 29. 38 Deep inguinal ring ↑ intra –abdominal pressure Superficial inguinal ring Conjoint tendon Reinforced anterior wall Reinforced posterior wall Weakness here leads to direct inguinal hernias Direct hernia S.C. Dr C Slater, Department of Human Biology, University of Cape Town
  30. 30.  Pass through the deep ring  Travel along the canal  Exit the superficial ring above and medial to the pubic tubercle (remember the inguinal ligament attaches to the tubercle). Since the incurved inguinal ligament forms the floor of the canal, the contents of the canal could not emerge below or lateral to the public tubercle (useful in surgical diagnosis). An example is congenital inguinal hernia.  Coverings of indirect hernias 39 Dr C Slater, Department of Human Biology, University of Cape Town
  31. 31.  Peritoneum  Internal spermatic fascia (from transversalis fascia)  Cremaster muscle & fascia (from transversus abdominis and internal oblique mm.)  External spermatic fascia (from external oblique m.)  Superficial fascia  Skin 40 This is a list that you can reason out yourself. Work out the covering layers based on the abdominal wall layers. Dr C Slater, Department of Human Biology, University of Cape Town
  32. 32.  If the posterior wall of the canal is weakened medially (e.g. by chronically increased intra- abdominal pressure), it can stretch and bulge out through the superficial ring  The contents of the hernia do not travel along the length of the canal but push directly on the stretched posterior inguinal canal wall and through the superficial ring.  Coverings of direct hernias 41 Dr C Slater, Department of Human Biology, University of Cape Town
  33. 33.  Peritoneum  Transversalis fascia  Conjoint tendon  External oblique aponeurosis  Superficial fascia  Skin 42 This is a list that you can reason out yourself. Work out the layers based on the anatomy. This will facilitate your understanding. Dr C Slater, Department of Human Biology, University of Cape Town
  34. 34.  A potential weakness  A design to lessen weakness:  Oblique passage weakest areas lying some→ distance apart  Anterior reinforcement by Int. oblique in front of deep ring  Posterior reinforcement by Conjoint tendon behind superficial ring
  35. 35. On coughing/straining (defecation, parturition etc.) → Internal oblique and transversus abdominis muscles contract → flattening the roof canal is→ virtually closed
  36. 36.  The inguinal ligamen spans the subinguinal space, through which pass flexors of the hip and the neurovascular structures serving much of the lower limb. 1. Two muscles: psos & iliacus 2. Two large vessels: femoral arerty & vein 3. Two nerves: femoral nerve between ilicus & psos and lateral cutaneous nerve of thigh. This nerve pierces or passes behind inguinal ligament one cm medial to ASIS.
  37. 37.  The inferior epigastric vessels are important posterior relations of the medial end of the canal. They lie on the transversalis fascia as they ascend obliquely behind the conjoint tendon into the posterior portion of the rectus sheath.  The inguinal triangle lies in the posterior wall of the canal. It is bounded inferiorly by the medial half of the inguinal ligament, medially by the lower lateral border of rectus abdominis and laterally by the inferior epigastric artery. It overlies the medial inguinal fossa and, in part, the supravesical fossa.
  38. 38.  Pectineal (backward)extension of inguinal ligament to pectineal line (pectin pubis)  Pectineal ligament is lateral extension of inguinal ligament along pectineal line. • Represents the medial triangular expansion of the inguinal ligament to the pectineal line of the pubis. • Forms the medial border of the femoral ring and the floor of the inguinal canal.
  39. 39.  The lacunar ligament is a thick triangular band of tissue lying mainly posterior to the medial end of the inguinal ligament.  It measures 2 cm from base to apex and is a little larger in the male.  It is formed from fibres of the medial end of the inguinal ligament and fibres from the fascia lata of the thigh, which join the medial end of the inguinal ligament from below.  The inguinal fibres run posteriorly and laterally to the medial end of the pectineal line and are continuous with the pectineal fascia.  They form a near horizontal, triangular sheet with a curved medial border. This edge forms the lateral border of the femoral canal. The apex of the triangle is attached to the pubic tubercle.
  40. 40. Inconstant Thin triangular band which passes upwards & medially from medial part of inguinal ligament
  41. 41.  INGUINAL HERNIA: An inguinal hernia involves the protrusion of a viscus through the tissues of the inguinal region of the abdominal wall.  Indirect inguinal hernia:An indirect hernia is defined as arising lateral to the inferior epigastric vessels. Many indirect hernias are related to the congenital abnormal persistence of the vaginal process.  Direct inguinal hernia:A direct inguinal hernia is defined as arising medial to the inferior epigastric vessels. Direct hernias are always caused by an acquired weakness of the inguinal triangle in the medial posterior wall of the canal, and frequently extend through the anterior wall of the canal or superficial ring.
  42. 42.  Femoral hernia:A femoral hernia protrudes through the femoral ring. The femoral ring is normally closed by a femoral septum of modified extraperitoneal tissue, and is therefore a weak spot. In females, the ring is relatively large and subject to profound changes during pregnancy, explaining why femoral hernias are more common in women.  The pubic tubercle is an important landmark in distinguishing inguinal from femoral hernias; the neck of the hernia is superomedial to it in inguinal hernia, but inferolateral in the femoral form.
  43. 43.  The interfoveolar ligament is a thickening of the transversalis fascia at the medial side of the internal inguinal ring. It lies in front of the inferior epigastric vessels like a spider web. It is not a true ligament, and when well- developed, one has the impression that it is only a lateral condensation of the ligament of Henle.
  44. 44.  Inconstant  Thin triangular band which passes upwards & medially from medial part of inguinal ligament (from the pubic tubercle )reflected from the pubic tubercle upward toward the linea alba..  Also has some reflection from the lacunar ligament.
  45. 45.  If the funicular process is unobliterated in the female a small diverticulum from the peritoneum(canal of Nuck) accompanies the round ligament in the inguinal canal.  A peritoneal diverticulum in the embryonic lower anterior abdominal wall that traverses the inguinal canal; in the male it forms the tunica vaginalis testis and normally loses its connection with the peritoneal cavity; a persistent processus vaginalis in the female is known as the canal of Nuck.  Syn: Nuck's diverticulum, processus vaginalis peritonei, vaginal process of peritoneum.
  46. 46. The gut tube can herniate into the path of the testis. Inguinal hernias breach the weakness of the abdominal wall around the path of the testis. Indirect inguinal hernias (A) result when a section of intestine follows the same route as the testis, pushing the peritoneum into the bulge that it created during migration. Indirect hernias parallel the spermatic cord and can distend the scrotum. Direct inguinal hernias (B) result when abdominal pressure exceeds the strength of the abdominal wall medial to the superficial inguinal ring and the path of the inferior epigastric artery. They are caused by intense pressure, such as when lifting a heavy weight improperly, and form a bulge of the abdominal wall, typically above the root of the scrotal sac.
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