Internal abdominal wall and inguinal region Mathew Wedel, 2015

gut tube

umbilicus

gut tube

gut tube

gut tube

dorsal mesentery

ventral mesentery

visceral peritoneum

parietal peritoneum

dorsal mesentery

visceral peritoneum

parietal peritoneum

MIDGUT & HINDGUT

FOREGUT

gut tube

gut tube

dorsal mesentery

ventral mesentery

visceral peritoneum

parietal peritoneum

dorsal mesentery

visceral peritoneum

parietal peritoneum

MIDGUT & HINDGUT

FOREGUT

Aorta

anterior superior iliac spine (ASIS)

pubic tubercles

pubic symphysis

anterior superior iliac spine (ASIS)

pubic tubercles

pubic symphysis

inguinal ligament (Poupart’s ligament

iliopectineal arch

lacuna musculorum

lacuna vasorum together constitute retroinguinal space

lacuna musculorum

lacuna vasorum together constitute retroinguinal space

lateral femoral cutaneous N

femoral N

iliacus (lateral) and psoas (medial) MM

lacuna musculorum

lacuna vasorum together constitute retroinguinal space

pectineal ligament (Cooper’s ligament)

lacunar ligament (Gimbernat’s ligament)

lacuna musculorum

lacuna vasorum together constitute retroinguinal space

external iliac A&V (become femoral A&V

past inguinal lig.)

femoral ring (entrance to

femoral canal)

umbilicus - single

falciform ligament (ventral mesentery)

- single

ligamentum teres (obliterated umbilical V)

- single

umbilicus - single

ligamentum teres (obliterated umbilical V)

- single

falciform ligament (ventral mesentery)

- single

bladder

mediaN umbilical lig. (obliterated urachus)

- single

umbilicus - single

ligamentum teres (obliterated umbilical V)

- single

falciform ligament (ventral mesentery)

- single

mediaN umbilical lig. (obliterated urachus)

- single

bladder

mediaL umbilical lig. (obliterated umbilical A)

- paired

internal iliac A (many branches,

see future lecture) - paired

umbilicus - single

ligamentum teres (obliterated umbilical V)

- single

falciform ligament (ventral mesentery)

- single

mediaN umbilical lig. (obliterated urachus)

- single

bladder

mediaL umbilical lig. (obliterated umbilical A)

- paired

internal iliac A (many branches,

see future lecture) - paired

rectus abdominis

M

umbilicus - single

ligamentum teres (obliterated umbilical V)

- single

falciform ligament (ventral mesentery)

- single

mediaN umbilical lig. (obliterated urachus)

- single

bladder

mediaL umbilical lig. (obliterated umbilical A)

- paired

internal iliac A (many branches,

see future lecture) - paired

lateral umbilical fold (inferior epigastric A&V)

- paired

Contrast the unpaired, midline structures associated with the gut tube and urogenital system with the bilaterally paired structures derived from the iliac vessels.

rectus abdominis

M

interfoveolar ligament (Hesselbach’s ligament)

- continuous with transversus abdominis M

deep inguinal ring (in lateral umbilical fossa)

interfoveolar ligament (Hesselbach’s ligament)

- continuous with transversus abdominis M

ductus deferens

testicular A&V (internal spermatic vessels)

deep inguinal ring (in lateral umbilical fossa)

femoral ring (entrance to

femoral canal)

deep inguinal ring (in lateral umbilical fossa)

supravesical fossa

femoral ring (entrance to

femoral canal)

deep inguinal ring (in lateral umbilical fossa)

supravesical fossa

femoral ring (entrance to

femoral canal)

Hesselbach’s triangle (medial inguinal fossa)

- lies posterior to superficial inguinal ring

deep inguinal ring (in lateral umbilical fossa)

supravesical fossa

femoral ring (entrance to

femoral canal)

Hesselbach’s triangle (medial inguinal fossa)

- lies posterior to superficial inguinal ring

deep inguinal ring (in lateral umbilical fossa)

x

x Cross-section diagram by Rocco Cusari, from: https://commons.wikimedia.org/wiki/File:Inguinal_fossae.PNG#/media/File:Inguinal_fossae.PNG

INdirect inguinal hernia – Peritoneal contents pass through INguinal canal, including both deep and superficial rings. May not involve any tearing of tissues, especially if processus vaginalis is patent. Accounts for ~75% of inguinal hernias. Ten times more common in males than in females, because of larger inguinal canal.

Direct inguinal hernia – Peritoneal contents push through tear in abdominal wall, most commonly emerging through superficial inguinal ring. Necessarily involves tearing the conjoint tendon (internal oblique and transversus abdominis aponeuroses). May also tear external oblique aponeurosis if hernia proceeds through supravesical fossa (rare). Accounts for ~25% of inguinal hernias, mostly in males older than 40.

Femoral hernia – Peritoneal contents pass through femoral ring, emerge inferior to inguinal ligament. May not involve any tearing of tissues. More common in females than in males, because of proportionally wider bone structure of female pelvis.

Triangle of Pain - contains major

nerves

Triangle of Doom - contains major

vessels

Blank version to practice on