Inguinal Region – Anatomy, Peritoneal Landmarks, Infraumbilical Fossae

Anatomy of the Inguinal Region

The ‘Myopectineal Orifice of Fruchaud’

Henry Fruchaud
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.
Myopectineal orifice of Fruchaud
Myopectineal orifice of Fruchaud

The Peritoneal Landmarks

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

The Infraumbilical Fossae

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.

Hesselbach’s Triangle (by Franz Caspar Hesselbach)

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

Iliopubic Tract

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.

Transversalis Fascia (of Gallaudet)

This fascia is a two layered structure (bilaminar). The anterior layer is adherent to the rectus abdominis muscle. The posterior layer lies in between the anterior layer and the peritoneum. It divides this space into an anterior (vascular space) and a posterior (Space of Bogros). Medially it is continuous with the space of Retzius. One should work in the space of Bogros to prevent unnecessory oozing.

Prevesical space of Retzius

The preperitoneal space that lies deep to the supravesical fossa and the medial umbilical fossa is the prevesical space of Retzius (Described in 1858, by Swedish anatomist Anders Retzius). This space contains loose connective tissue and fat.

Important structures in this space are:

Arteries

  1. External iliac artery
  2. Inferior epigastric artery and its branches

Veins

  1. External iliac vein
  2. Inferior epigastric veins
  3. Deep venous circulation

Nerves

  1. Lateral femoral cutaneous nerve
  2. Genitofemoral nerve
  3. Femoral nerve
  4. Ilioinguinal nerve
  5. Iliohypogastric nerve
  6. Lymphatics and lymph nodes

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