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.
