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Inguinal Region – Anatomy, Peritoneal Landmarks, Infraumbilical Fossae – Part 1

Anatomy of the Inguinal Region

Henry Fruchaud

All groin (inguinofemoral) hernias originate in a single weak area called the myopectineal orifice. This oval, funnel-like, ‘potential’ orifice formed by the following structures, makes the ‘myopectineal orifice of Fruchaud’.
-Henry Fruchaud

Boundaries

  • Superiorly Internal oblique and transversus abdominis muscles.
  • Inferiorly Superior pubic ramus.
  • Medially Rectus muscle sheath.

Median Umbilical Ligament:

This ligament ascends in the median plane from the apex of the bladder to the umbilicus. It represents the obliterated allantoic duct and its lower part is the site of the rare urachal cyst.

Medial Umbilical Ligament

This ligament represents the obliterated umbilical artery on each side and can be traced down to the internal iliac artery.

Lateral Umbilical Ligament

It is the ridge of peritoneum, which is raised by the inferior epigastric vessels.

These ligaments delineate the infraumbilical fossae

The Infraumbilical ligaments
The infraumbilical ligaments

These fossae are important for surgeons-

  1. Delineate the sites of groin herniation.
  2. An important landmark for orientation during hernia repairs.

Supravesical fossae:

The infraumbilical area between the median and medial umbilical
ligaments. This is the site for the origin of the supravesical hernia.

Medial Umbilical fossae:

The infraumbilical area between the medial and lateral umbilical
ligaments. This is the site for the origin of the femoral and direct inguinal hernia.

Lateral Umbilical fossae:

The infraumbilical area lateral to the lateral umbilical ligament. This is
the site for the origin of the indirect inguinal hernia.

1.Superolateral boundaryInferior epigastric vessels
2Medial boundaryRectus sheath
3.Inferior boundaryCooper’s ligament/
Inguinal ligament

It is the site for direct hernia

Hesselbach’s triangle
Hesselbach’s triangle

The iliopubic tract is a thickened lateral extension of the transversalis fascia, which runs from the superior pubic ramus to the iliopectineal arch and the anterior superior iliac spine. It is intimately associated with the inguinal ligament. It is anterior to the Cooper’s ligament and posterior to the inguinal ligament. The iliopubic tract separates the internal ring from the femoral canal. It is visualized as a fibrous (white) tract.

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Contact Details

Dr. R. Padmakumar
MBBS, DNB, MNAMS, DipALS, FAIS, FIMSA, FCLS, FRCS (GL)
Senior Consultant Laparoscopic and Metabolic Surgeon &
Director - Verwandeln Institute (Transforming Lives)
(Specialist in Laparoscopy, Hernia, Cancer, Obesity Surgery or Bariatric Surgery, Diabetes Surgery, Endoscopic Thyroid Surgery, Thoracoscopy, Intragastric Balloon)
Keyhole Clinic, Thammanam Road, Plarivattom, Kochi, Kerala, India
VPS Lakeshore Hospital, Maradu, Kochi, Kerala, India
VSM Hospital, Mavelikkara, Kerala, Kochi, India
Chairman - Association of Surgeons of India, Kerala Chapter

Address

Keyhole Clinic - Center for Obesity and Laparoscopy

Palarivattom, Kochi, Kerala

VPS Lakeshore Hospital

Maradu, Kochi, Kerala


Mobile: +919447230370, +919846320370
Email: [email protected]

Website:
www.drrpadmakumar.com

Chairman, Association of Surgeons of India - Kerala Chapter
National President - Indian Hernia Society (2016)
GC Member, Association of Surgeons of India (2013 - 2018)
Vice President- Society of Endoscopic and Laparoscopic Surgeons of India
Jt. Secretary - Indian Association of Endocrine Surgeons (2016)
Founder Member, Obesity and Metabolic Surgery Society Of India
Founder Member, Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Diabetic Surgery
Associate Editor : Diabetes and Obesity International Journal