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Anatomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Ernest F. Talarico, Jalid Sehouli, Giuseppe Del Priore, Werner Lichtenegger
The internal iliac artery divides into anterior and posterior divisions (Figure 4.8). The branches that arise from the posterior division are the iliolumbar, sacral arteries, and the superior gluteal artery. The first branch to arise from the anterior division may be the iliolumbar artery. This aside, the umbilical artery (obliterated hypogastric vessel) is the first major branch, and it runs along the lateral pelvic wall then ascends toward the umbilicus giving rise to superior vesicular arteries and terminating as the medial umbilical ligament. This ligament raises a fold of peritoneum (medial umbilical fold), and identification of the umbilical ligament is very helpful in the preparation of the parametrium during radical hysterectomy.
Anatomically Based Surgical Dissection for Deep Endometriosis Surgery
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Mohamed Mabrouk, Diego Raimondo, Alessandro Arena, Renato Seracchioli
During a transperitoneal inspection, without opening the peritoneum, some retroperitoneal structures can be simply identified:Median, right and left medial, and right and left lateral umbilical folds. The median umbilical fold extends from the apex of the bladder to the umbilicus and contains the urachus; the medial umbilical fold covers the obliterated umbilical artery; the lateral umbilical fold contains the deep inferior epigastric vessels, below their entry into the rectus sheathSuperior vesical arteries, on both sides, forming the transverse vesical folds on the bladder domeUterine artery, on both sides, passing between the two peritoneal layers of the broad ligament, within the cardinal ligament (of Mackenrodt or lateral parametrium), and crossing over the ureterPelvic ureter, entering the lesser pelvis in extraperitoneal areolar tissue at the level of the sacral promontory, anterior to the end of the common iliac vessels (more frequent on the left side) or at the origin of the external iliac vessels (more frequent on the right side). In women, the pelvic part anterior to the internal iliac artery is behind the ovary, forming the posterior boundary of the ovarian fossa (of Krause). Along the broad ligament, the uterine artery is anterosuperior to the ureter for about 2.5 cm and then crosses to its medial side to ascend alongside the uterus.Uterosacral ligaments, forming the rectouterine folds, containing pelvic autonomic nerve fibers in its posterolateral part. In some patients, it is also visible a more medial and caudal folder, enveloping the hypogastric nerves and the inferior hypogastric plexus (or pelvic plexus)Bifurcation of aorta (at the level of the L4 vertebra or the L4/5 intervertebral disc, to the left of the midline) and the left common iliac vein. Caudally, middle sacral vessels and the superior hypogastric plexus are located in the interiliac triangle (or Cotte triangle) at the level of sacral promontory. The superior hypogastric plexus is a network formed by branches from the aortic plexus (sympathetic and parasympathetic); lumbar splanchnic nerves (sympathetic); and pelvic splanchnic nerves (parasympathetic), regulating rectal, low urinary tract and upper genital functionsLaterally, three somatic nerves coming from the lumbar plexus: Genitofemoral nerve, lying on the psoas major muscle, the iliohypogastric and the ilioinguinal nerves.
The Septum Inguinalis: A Clue to Hernia Genesis?
Published in Journal of Investigative Surgery, 2020
Giuseppe Amato,, Piergiorgio Calò,, Vito Rodolico,, Roberto Puleio,, Antonino Agrusa,, Leonardo Gulotta,, Luca Gordini,, Giorgio Romano,
Recognition of the septum inguinalis, and the fact that it may degenerate into oblivion from the compressive effect of advanced pantaloon hernia in the form of a combined hernia, allows a revision of the traditional anatomic concepts in relation to the inguinal canal. Classically the inguinal floor is described in 2 parts: Hesselbach’s triangle medial to the epigastric vessels and the deep inguinal ring laterally [15–19]. However, functionally this may not be correct. On the basis of the cases reported here and many others we have encountered in our clinical practice [3] we characterize the functional anatomy of the inguinal floor as follows:A medial aspect consisting of the fossa supravesicalis—fossa inguinalis media complex. These 2 zones, longitudinally divided by the medial umbilical fold and covered in the posterior aspect by the transversalis fascia, are tightly connected and often involved together in direct hernia protrusion.An intermediate aspect: the septum inguinalis that divides the medial from the lateral part of the inguinal floor. This comprises, anteriorly, the muscle bundles of the internal oblique and transverse, covered by the transversalis fascia and forming the medial border of the deep inguinal ring. Posteriorly is composed by the epigastric vessels and sheath. The latter may act as a protective shield as it is the last recognizable structure to disappear when a combined hernia converges into a single protrusion. Comprising more than just the inferior epigastric vessels, the septum inguinalis structure includes the lateral part of the fossa inguinalis media and the medial part of the internal ring.A lateral aspect that comprises the transversalis fascia and deep inguinal ring, its medial aspect being functionally connected with the septum inguinalis.