c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Anterior Inguinal Hernia Anatomy: 1

A D V E R T I S E M E N T

   
 

The inguinal ligament spans between the anterior superior iliac spine and the pubic tubercle. The iliopsoas muscle fills the lateral space between inguinal ligament and iliopubic ramus, and the iliac vessels pass beneath inguinal ligament midway between its bony attachments. The internal spermatic vessels, genital branch of the genitofemoral nerve and vas pass through the abdominal wall via the deep inguinal ring just cephalad to the vessels and lateral to their inferior epigastric branches. Pectineal (Cooper's) ligament is the thickened periosteum on the pectineal ridge of the superior pubic ramus passing behind the iliac vessels. The medial umbilical ligament is the remnant of the umbilical artery crossing deep to the inguinal floor just lateral to the bladder.   

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Anterior Inguinal Hernia Anatomy: 2

A D V E R T I S E M E N T

   
 

The parietal peritoneum covers the deep side of theinguinal floor and reflects onto the iliac vessels and iliopsoas muscleposteriorly. The inferior epigastric vessels, vas, iliac and internal spermaticvessels and medial umbilical ligament lie just outside the peritoneum and can usually be discerned beneath its surface when viewed from inside the abdomen.      

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Anterior Inguinal Hernia Anatomy: 3

A D V E R T I S E M E N T

   
 

The transversalis fascia lines the abdominal cavity outside the parietal peritoneum and sandwiches the epigastric vessels and medial umbilical ligament within a layer of preperitoneal fat between itself and peritoneum. The transversalis fascia comprises the "inguinal floor" and is the key layer for understanding inguinal anatomy. It surrounds the spermatic cord structures as they exit the abdomen forming the deep inguinal ring, and extends as the internal spermatic fascia on the cord surface. Transversalis fascia also encircles the iliac/femoral vessels as they pass beneath inguinal ligament and forms the femoral sheath. The transversalis fascia is adherent to the shelving edge of the inguinal ligament, obscuring the anterior view of Cooper's ligament. The lower portion of the rectus abdominus muscle lies directly anterior to transversalis fascia, having no posterior sheath below the arcuate line.   

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This page was last modified on 3/1/1999.