Internal abdominal wall and
inguinal region
Mathew Wedel, 2015
gut
tube
umbilicus
gut
tube
dorsal
mesentery
visceral
peritoneum
gut
tube
FOREGUT
dorsal
mesentery
parietal
peritoneum
MIDGUT &
HINDGUT
gut
tube
visceral
peritoneum
parietal
peritoneum
ventral
mesentery
dorsal
mesentery
Aorta
visceral
peritoneum
gut
tube
FOREGUT
dorsal
mesentery
parietal
peritoneum
MIDGUT &
HINDGUT
gut
tube
visceral
peritoneum
parietal
peritoneum
ventral
mesentery
anterior superior
iliac spine (ASIS)
pubic tubercles
pubic symphysis
anterior superior
iliac spine (ASIS)
inguinal ligament
(Poupart’s ligament
pubic tubercles
iliopectineal arch
pubic symphysis
lacuna musculorum
together constitute
retroinguinal space
lacuna vasorum
lateral femoral
cutaneous N
femoral N
iliacus (lateral) and
psoas (medial) MM
lacuna musculorum
together constitute
retroinguinal space
lacuna vasorum
pectineal ligament
(Cooper’s ligament)
lacunar ligament
(Gimbernat’s ligament)
lacuna musculorum
together constitute
retroinguinal space
lacuna vasorum
external iliac A&V
(become femoral A&V
past inguinal lig.)
femoral ring
(entrance to
femoral canal)
lacuna musculorum
together constitute
retroinguinal space
lacuna vasorum
falciform ligament
(ventral mesentery)
- single
ligamentum teres
(obliterated umbilical V)
- single
umbilicus - single
falciform ligament
(ventral mesentery)
- single
ligamentum teres
(obliterated umbilical V)
- single
umbilicus - single
mediaN umbilical lig.
(obliterated urachus)
- single
bladder
falciform ligament
(ventral mesentery)
- single
mediaL umbilical lig.
(obliterated umbilical A)
- paired
ligamentum teres
(obliterated umbilical V)
- single
umbilicus - single
mediaN umbilical lig.
(obliterated urachus)
- single
internal iliac A
(many branches,
see future lecture)
- paired
bladder
mediaL umbilical lig.
(obliterated umbilical A)
- paired
rectus
abdominis
M
falciform ligament
(ventral mesentery)
- single
ligamentum teres
(obliterated umbilical V)
- single
umbilicus - single
mediaN umbilical lig.
(obliterated urachus)
- single
internal iliac A
(many branches,
see future lecture)
- paired
bladder
mediaL umbilical lig.
(obliterated umbilical A)
- paired
rectus
abdominis
M
ligamentum teres
(obliterated umbilical V)
- single
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.
internal iliac A
(many branches,
see future lecture)
- paired
falciform ligament
(ventral mesentery)
- single
umbilicus - single
mediaN umbilical lig.
(obliterated urachus)
- single
bladder
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
deep inguinal ring
(in lateral umbilical fossa)
testicular A&V
(internal spermatic vessels)
ductus
deferens
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)
Hesselbach’s triangle
(medial inguinal fossa)
- lies posterior to
superficial inguinal ring
supravesical
fossa
femoral ring
(entrance to
femoral canal)
deep inguinal ring
(in lateral umbilical fossa)
x
Hesselbach’s triangle
(medial inguinal fossa)
- lies posterior to
superficial inguinal ring
supravesical
fossa
femoral ring
(entrance to
femoral canal)
Cross-section diagram by Rocco Cusari, from:
https://commons.wikimedia.org/wiki/File:Inguinal_fossae.PNG#/media/File:Inguinal_fossae.PNG
x
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