Lecture 01 Internal surface of anterolateral abdominal wall. BY Dr Farooq Khan Aurakzai

Transcription

1 Lecture 01 Internal surface of anterolateral abdominal wall BY Dr Farooq Khan Aurakzai Dated:

2 Internal surface of the anterolateral abdominal wall The internal ( posterior ) surface of the anterolateral abdominal wall is covered with: Transversalis fascia A variable amount of extraperitoneal fat And parietal peritoneum. 2

3 Internal surface of the anterolateral abdominal wall The internal surface of the anterolateral wall present two parts: Infra umbilical part and Supra umbilical part. INFerior to the umbilicus: The infra umblical part of this surface exhibits five umbilical peritoneal folds passing toward the umbilicus : One in the median plane Two on each side. 3

4 Internal surface of the anterolateral abdominal wall 1. Median Umbilical folds In the midline, there are elevations of peritoneum with free edges, called folds. INFERIOR to the umbilicus: The median umbilical fold extends from the apex of the urinary bladder to the umbilicus and covers the median umbilical ligament. It is a fibrous remnant of the urachus that joined the apex of the fetal bladder. 4

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6 2. Medial Umbilical Folds Two medial umbilical folds, lateral to the median umbilical fold, cover the medial umbilical ligaments. It is formed by occluded parts of the umbilical arteries. 6

7 3. Lateral Umbilical Folds Two lateral umbilical folds, lateral to the medial umbilical folds. It covers the inferior epigastric vessels and therefore bleed if cut. It is patent even after birth. 7

8 Internal surface of anterior abdominal wall SUPRA UMBILICAL PART: The supraumbilical part of the internal surface of the anterior abdominal wall has a sagittally oriented peritoneal reflection. The falciform ligament, that extends between the superior anterior abdominal wall and the liver. It encloses the round ligament of the liver, and the paraumbilical veins in its inferior free edge. 8

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10 Internal surface of anterior abdominal wall The round ligament is a fibrous remnant of the umbilical vein, which passed from umbilicus to the liver prenatally. 10

11 Median umbilical ligament The median umbilical ligament or Xander s ligament. It extends from the apex of the bladder to the umbilicus, on the deep surface of the anterior abdominal wall. It is unpaired. It is covered by the median umbilical fold. It should not be confused with the medial umbilical ligament, as: Median Umbilical ligament.urachus. Medial Umbilical ligament..obliterated Umbilical arteries. It may be used as a landmark for surgeons who are performing laparoscopy, such as laparoscopic inguinal hernia repair. 11

12 Internal surface of the anterolateral abdominal wall The depression lateral to the umbilical folds are the peritoneal fossae, each of which is a potential site for the hernia. 12

13 Internal surface of the anterolateral abdominal wall The shallow fossae between the umbilical folds are the : Supravesical fossae (C in Figure) Medial inguinal fossae (B in Figure) Lateral inguinal fossae (A in Figure) 13

14 Supravesical fossae Supravesical fossae lies between the median and the medial umbilical folds. It is formed as the peritoneum reflects from the anterior abdominal wall onto the bladder. The level of the supravesical fossae rises and falls with filling and emptying of the bladder. 14

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16 Medial inguinal fossae Medial inguinal fossae between the medial and the lateral umbilical folds, areas also commonly called inguinal triangles ( Hessel bach s triangles). It is the potential sites for the less common direct inguinal hernias. 16

17 Hesselbach s triangles The inguinal triangle/ Hesselbach s triangle is a triangular fossa of the abdominal wall. Boundaries Medial border: Lateral margin of the rectus sheath Superolateral border: Inferior epigastric vessels Inferior border: Inguinal ligament 17

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19 Lateral inguinal fossae Lateral inguinal fossae, lateral to the lateral umbilical folds, include the deep inguinal rings. It is a potential sites for the most common type of hernia in the lower abdominal wall, the Indirect Inguinal Hernia. 19

20 ARCUATE LINE The arcuate line of the abdomen, linea semicircularis or Douglas' line. It is a horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath. It is also where the inferior epigastric vessels perforate the rectus abdominis. 20

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23 Post natal patency of the umbilical vein The umbilical vein is a vein present during fetal development that carries oxygenated blood from the placenta into the growing fetus. The umbilical vein provides convenient access to the central circulation of a neonate for restoration of blood volume and for administration of glucose and drugs. Closure of the umbilical vein usually occurs after the umbilical arteries have closed. 23

24 post natal patency of the umbilical vein..con t Within a week of birth, the neonate's umbilical vein is completely obliterated and is replaced by a fibrous cord called the round ligament of the liver (also called ligamentum teres hepatis). It extends from the umbilicus to the transverse fissure, where it joins with the falciform ligament of the liver. It separate segment 4 from segments 2 and 3 of the left hepatic lobe. 24

25 Supravesical hernia A rare cause of intestinal obstruction Supravesical hernia is an unusual type of hernia. It is of two types: Internal and External. It was reported by Sir Astley Cooper in The internal type is more difficult to diagnose and commonly presents as intestinal obstruction or undiagnosed abdominal pain. The external type is medial to the direct inguinal hernia. The iliohypogastric nerve is in danger of injury during the repair of this type of hernia. 25

26 Internal surface of the anterolateral abdominal wall The location of a hernia in one of these fossae determines how the hernia is classified. 26

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