{"id":1654,"date":"2020-02-07T07:35:56","date_gmt":"2020-02-07T07:35:56","guid":{"rendered":"https:\/\/www.drrpadmakumar.com\/blog\/?p=1654"},"modified":"2025-12-02T09:49:36","modified_gmt":"2025-12-02T09:49:36","slug":"inguinal-anatomy-the-peritoneum-incised","status":"publish","type":"post","link":"https:\/\/www.drrpadmakumar.com\/blog\/inguinal-anatomy-the-peritoneum-incised\/","title":{"rendered":"Inguinal Anatomy with Peritoneum Incised"},"content":{"rendered":"\n<div><a class=\"btn btn-info\" href=\"https:\/\/www.drrpadmakumar.com\/blog\/inguinal-anatomy-with-the-peritoneum-intact\/\">Previous Page &#8211; Inguinal Anatomy with Peritoneum Intact<\/a><\/div>\n\n\n\n<div style=\"height:21px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>After the peritoneum is dissected away, six additional structures need to be identified. They are <\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Pubic crest (Lighthouse sign), <\/li>\n\n\n\n<li>Iliopubic tract,<\/li>\n\n\n\n<li>Cooper\u2019s ligament,<\/li>\n\n\n\n<li>Femoral canal<\/li>\n\n\n\n<li>Obturator nerve and<\/li>\n\n\n\n<li>Internal inguinal\/ spermatic ring<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading page-header\">Pubic Crest:<\/h2>\n\n\n\n<p>It helps in getting orientation. Beware of small veins overlying. If they bleed entire vision gets spoiled.<\/p>\n\n\n\n<h2 class=\"wp-block-heading page-header\">Iliopubic Tract:<\/h2>\n\n\n\n<p>The iliopubic tract is a thick fibrous white  tract which runs from the superior pubic ramus to the anterior superior iliac spine.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The iliopubic tract separates the inguinal region from the femoral canal.<\/li>\n\n\n\n<li>Sutures or tacks should never be placed below the  level of the iliopubic tract laterally<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading page-header\">Cooper\u2019s Ligament:<\/h2>\n\n\n\n<p>This ligament is a condensation of  the transversalis fascia and periosteum located lateral to the pubic symphysis. It is densely adherent to the pubic ramus and joins the iliopubic tract and lacunar ligaments at their medial insertions. This ligament is used to anchor the mesh in huge direct hernias.<\/p>\n\n\n\n<p>Mobilizing adipose tissue around the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cooper%27s_ligaments\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Cooper\u2019s ligament (opens in a new tab)\">Cooper\u2019s ligament<\/a> can injure an aberrant obturator artery, which might course over it.  Injury to this vessel results in distressing bleeding.  This unfortunate morbidity has resulted in the naming of this vessel Corona mortis (crown of death).<\/p>\n\n\n\n<h2 class=\"wp-block-heading page-header\">Femoral Canal:<\/h2>\n\n\n\n<p>It denotes the potential site of origin of a <a href=\"https:\/\/www.drrpadmakumar.com\/blog\/femoral-hernia\/\"> femoral hernia<\/a>. The canal lies posterior to the iliopubic tract.<\/p>\n\n\n\n<h2 class=\"wp-block-heading page-header\">Obturator Nerve:<\/h2>\n\n\n\n<p>It courses in the lateral <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pelvic_cavity\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"pelvic wall (opens in a new tab)\">pelvic wall<\/a>. Mesh  placement should extend up to that region. It helps to take care of <a href=\"https:\/\/www.drrpadmakumar.com\/blog\/obturator-hernia\/\">obturator hernias<\/a>, especially in elderly.<\/p>\n\n\n\n<h2 class=\"wp-block-heading page-header\">Internal Inguinal Ring:<\/h2>\n\n\n\n<p>Denotes the site of origin of an  indirect <a href=\"https:\/\/www.drrpadmakumar.com\/blog\/inguinal-hernia\/\">inguinal hernia<\/a>. The most reliable indicator of the internal ring is the junction of the testicular vessels and the<br> spermatic cord in a male and entry of round ligament in a female.<\/p>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"330\" height=\"194\" data-id=\"1667\" data-src=\"https:\/\/www.drrpadmakumar.com\/blog\/wp-content\/uploads\/2020\/02\/triangle-of-doom.jpg\" alt=\"Inguinal Anatomy with Peritoneum Incised - Triangle of Doom\" class=\"wp-image-1667 lazyload\" data-srcset=\"https:\/\/www.drrpadmakumar.com\/blog\/wp-content\/uploads\/2020\/02\/triangle-of-doom.jpg 330w, https:\/\/www.drrpadmakumar.com\/blog\/wp-content\/uploads\/2020\/02\/triangle-of-doom-300x176.jpg 300w\" data-sizes=\"(max-width: 330px) 100vw, 330px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 330px; --smush-placeholder-aspect-ratio: 330\/194;\" \/><figcaption class=\"wp-element-caption\">Triangle of Doom<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"330\" height=\"228\" data-id=\"1668\" data-src=\"https:\/\/www.drrpadmakumar.com\/blog\/wp-content\/uploads\/2020\/02\/triangle-of-pain.jpg\" alt=\"Inguinal Anatomy with Peritoneum Incised - Triangle of Pain\" class=\"wp-image-1668 lazyload\" data-srcset=\"https:\/\/www.drrpadmakumar.com\/blog\/wp-content\/uploads\/2020\/02\/triangle-of-pain.jpg 330w, https:\/\/www.drrpadmakumar.com\/blog\/wp-content\/uploads\/2020\/02\/triangle-of-pain-300x207.jpg 300w\" data-sizes=\"(max-width: 330px) 100vw, 330px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 330px; --smush-placeholder-aspect-ratio: 330\/228;\" \/><\/figure>\n<\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div><a class=\"btn btn-primary readmore\" href=\"https:\/\/www.drrpadmakumar.com\/blog\/tapp-inguinal-hernia-repair\/\">Continue Reading<\/a> <a class=\"btn btn-info\" href=\"https:\/\/www.drrpadmakumar.com\/blog\/laparoscopic-hernia-repair\/\">Table of Contents<\/a><\/div>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"bg-light p-2\"><h2 class=\"page-header\">Different Types of Hernias<\/h2><ul><li><a href=\"https:\/\/www.drrpadmakumar.com\/blog\/inguinal-hernia\/\">Inguinal hernia<\/a><\/li><li><a href=\"https:\/\/www.drrpadmakumar.com\/blog\/hiatal-hernia\/\">Hiatal hernia<\/a><\/li><li><a href=\"https:\/\/www.drrpadmakumar.com\/blog\/ventral-hernia\/\">Ventral Hernia<\/a><\/li><li><a href=\"https:\/\/www.drrpadmakumar.com\/blog\/obturator-hernia\/\">Obturator Hernia<\/a><\/li><li><a href=\"https:\/\/www.drrpadmakumar.com\/blog\/femoral-hernia\/\">Femoral Hernia<\/a><\/li><li>Umbilical hernia<\/li><li>Incisional hernia<\/li><\/ul><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Previous Page &#8211; Inguinal Anatomy with Peritoneum Intact After the peritoneum is dissected away, six additional structures need to be identified. They are Pubic Crest: It helps in getting orientation. Beware of small veins overlying. If they bleed entire vision gets spoiled. Iliopubic Tract: The iliopubic tract is a thick fibrous white tract which runs [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[54],"tags":[15],"class_list":["post-1654","post","type-post","status-publish","format-standard","hentry","category-publications","tag-hernia-surgery"],"_links":{"self":[{"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/posts\/1654","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/comments?post=1654"}],"version-history":[{"count":15,"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/posts\/1654\/revisions"}],"predecessor-version":[{"id":3278,"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/posts\/1654\/revisions\/3278"}],"wp:attachment":[{"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/media?parent=1654"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/categories?post=1654"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.drrpadmakumar.com\/blog\/wp-json\/wp\/v2\/tags?post=1654"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}