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Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
What defines direct and indirect hernia anatomically when seen laparoscopically?Inferior epigastric artery
SBA Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
B External iliac arteryThe inferior epigastric artery is a branch of the external iliac artery, just above the inguinal ligament; it runs upward and medially along the anterior abdominal wall medial to the internal inguinal ring. It then continues upward in the rectus sheath and eventually anastomoses with the superior epigastric artery, which is running downward in the sheath.
Hernias
Published in Sam Mehta, Andrew Hindmarsh, Leila Rees, Handbook of General Surgical Emergencies, 2018
Sam Mehta, Andrew Hindmarsh, Leila Rees
The hernial sac passes lateral to the inferior epigastric artery through the deep ring of the inguinal canal: it accounts for virtually all groin hernias in infants (incidence approximately 2%)it is twice as common as direct hernias in adults (occurs most frequently in younger men)it occurs as frequently as femoral hernias in womenit commonly extends into the scrotum (inguinoscrotal hernia)the incidence of strangulation is at least 10 times higher than for a direct inguinal hernia.
Comparison of 30-degree and 0-degree laparoscopes in the visualisation of the inferior epigastric vessel, rectus abdominis muscle and bladder dome in gynaecologic laparoscopy
Published in Journal of Obstetrics and Gynaecology, 2022
Satit Klangsin, Nantaka Ngaojaruwong, Hatern Tintara
In the lower abdominal wall, the inferior epigastric artery (IEA) mostly arises from the external iliac artery; however, variants may arise from the femoral artery or share a common trunk with the obturator artery (Wong and Merkur 2016). The IEA runs below the medial edge of the rectus abdominis muscle; the risk of damage to these vessels has led surgeons to opt for laparotomy to avoid any consequent massive haemorrhage (Lin and Grow 1999; Alkatout et al. 2015). The landmarks of the IEA and rectus abdominis muscle at the anterior superior iliac spine vary: 3.7–5.43 cm from midline and 5–6 cm from midline, respectively (Epstein et al. 2004; Rahn et al. 2010; Burnett et al. 2016; Joy et al. 2016, 2017). To prevent an IEA injury, various techniques have been proposed; the most common techniques are direct visualisation of the IEA, edge of the rectus abdominis muscle, and bladder dome via the primary port (Hurd et al. 2003).
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,
Histologically, the 19 excised septa also showed progressive changes, which correlated to the macroscopic findings. All cases showed medial hyperplasia of the artery, venous congestion, chronic inflammatory infiltration and degenerative change in the muscular structures. The luminal patency of the inferior epigastric artery was reduced to a variable degree by medial hyperplasia. Thrombotic occlusion with recanalization and also complete fibrotic obliteration of the vessels was evident in the advanced stages (Figures 6–8). The muscular arrangement showed all degrees of degenerative damage, from hyaline through fibrotic to fatty degeneration. Fatty muscle dysplasia was found consistently (Figures 6 and 7) Connective tissue showed edema and inflammatory infiltrate, signaling significant degenerative damage (Figures 6 and 7). Fibrotic degeneration of the nerve axons was also widespread (Figure 9A) and Wallerian degeneration could be detected in the late stages (Figure 9B). On overall view of the histological data indicates that all the identified tissue injuries are consistent with chronic compressive damage.
Embolization of a large progressive symptomatic desmoid tumor in the rectus muscle of a female patient with multiple sclerosis: a case report
Published in Acta Chirurgica Belgica, 2018
I. Diebels, M. Blockhuys, P. Willemsen, Y. Pirenne
Embolization was performed one month later. Arterial access was achieved by puncture of the left common femoral artery by Seldinger technique. The sheath was advanced into the left external iliac artery after which the inferior epigastric artery was selectively catheterized. On CT-guidance and after contrast injection, the main artery of the tumor was identified and super selectively catheterized with a 0.021'' microcatheter. No pathological blush was observed. Embolization was performed by injection off 45–150 μm contourparticles in 0.8 ml lipiodol ultrafluid and 0.5 ml histoacryl transparent. Control angiography showed successful occlusion of the main artery of the tumor. The catheters and sheath were removed and the puncture site was closed by manual compression. The patient was discharged in good health the following day.