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.
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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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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