What you were afraid to ask about the Surgical Anatomy of the Abdominal Wall

What you don’t dare to ask about the surgical anatomy of the Abdominal Wall.

– What’s the Arcuate line (of Douglas) and what structures does it separate? – What’s the Myopectineal Orifice (of Fruchaud) and what are its boundaries? – What’s the triangle of Doom and what is its surgical relevance?

TO ANSWER THE QUESTIONS

What’s the Arcuate line (of Douglas) and what structures does it separate?

– It’s a horizontal line that demarcates the lower limit of the posterior layer of the rectus sheath – It’s located about halfway from the umbilicus to the pubic crest – Superior to the arcuate line, the internal oblique aponeurosis splits to envelop the rectus abdominis muscle both anteriorly and posteriorly. – Inferior to the arcuate line, the internal oblique and transversus abdominis aponeuroses merge and pass superficial (i.e. anteriorly) to the rectus muscle.

What’s Fruchaud’s Myopectineal Orifice?

– It’s a distinct area of weakness in the inguinal region – It’s composed by two regions separated by the inguinal ligament; the suprainguinal region site for direct and indirect inguinal hernias, and a small subsegment of the subinguinal region, site for femoral hernias. – Its boundaries are as follows:

. Superior: Arch of the internal oblique muscle and the transversus abdominis muscle . Lateral: Iliopsoas muscle . Medial: Lateral edge of rectus abdominis muscle . Inferior: Pubic pecten

What’s the Triangle of Doom? – It’s a danger area located formed by the gonadal vessels laterally and the ductus deferens medially. These anatomic entities meet at the deep inguinal ring – Within this triangle are external iliac vessels – The point to be remembered is that the mesh, that we used in hernioplasty, should not be fixed in this region to avoid “doom” bleeding complications.