Monday, April 22, 2013

Umbilical ligaments and folds


The median umbilical ligament is a structure in human anatomy. It is a shrivelled piece of tissue that represents the remnant of the embryonic urachus.
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
Lateral to this structure are the medial umbilical ligament (which is a different structure, not to be confused) and the lateral umbilical ligament.
Significance
It may be used as a landmark for surgeons who are performing laparoscopy, such as laparoscopic inguinal hernia repair. Other than this, it has no function in a born human and may be cut or removed with impunity الإفلات من العقاب.

2- Medial umbilical ligament
The medial umbilical ligament (or cord of umbilical artery) is a paired structure found in human anatomy. It is on the deep surface of the anterior abdominal wall, and is covered by the medial umbilical folds (plica umbilicalis medialis). It should not be confused with the median umbilical ligament, a different structure that represents the remnant of the embryonic urachus.

Origins

It represents the remnant of the fetal umbilical arteries, which serves no purpose in humans after birth, except for the part that becomes the adult umbilical artery.

Functions

It may be used as a landmark for surgeons exploring the medial inguinal fossa during laparoscopic inguinal hernia repair. Other than this, it has no purpose in an adult and it may be cut or damaged with impunity.

Relations

The supravesical fossa, and therefore a supravesical hernia, is medial to this structure. The medial inguinal fossa, and therefore a direct inguinal hernia, is lateral to it.


3- Lateral Umbilical Ligaments
The inferior epigastric artery is a medial branch of the distal segment of the external iliac artery. It ascends along the medial margin of the deep inguinal ring, continues between the rectus abdominis muscle and the posterior lamina of its sheath, and then abuts محاذياً on the anterior parietal peritoneum to create the lateral umbilical ligament. This ligament is the least pronounced of the three aforementioned peritoneal folds, and it is not always readily visualized. However, knowledge of its location is important to avoid injury to these vessels during either insertion of the lateral trocars or dissection of the space of Retzius.

Lateral umbilical fold


The lateral umbilical fold overlies the inferior epigastric artery (a branch of the external iliac artery) and its accompanying veins. Unlike the median and medial umbilical folds, the contents of the Lateral Umbilical fold remain functional after birth. It extends from inguinal ring to arcuate line.

Clinical significance

The lateral umbilical fold is an important reference site with regards to hernia classification. A direct hernia occurs medial to the lateral umbilical fold, whereas an indirect hernia originates lateral to the fold. This later case is due to the placement of the opening of the deep inguinal ring in the space lateral to the lateral umbilical fold, which allows the passage of the ductus deferens, testicular artery, and other components of the spermatic cord in men, or the round ligament of the uterus in women.


Posterior view of the anterior abdominal wall in its lower half. The peritoneum is in place, and the various cords are shining through.







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