External Iliac Branches The inferior deep epigastric vessels and deep circumflex iliac vessels are branches of the external iliac vessels (see Fig. 38-3). They supply the muscles and fascia of the anterior abdominal wall. The inferior epigastric vessels initially course lateral to and then posterior to the rectus muscles, which they supply. They then pass anterior to the posterior rectus sheath and course between the sheath and the rectus muscles. Near the umbilicus, the inferior epigastric vessels anastomose with the superior epigastric artery and veins, branches of the internal thoracic vessels. Clinical Correlation The inferior epigastric vessels also can be injured during accessory trocar placement with laparoscopy. Techniques to avoid their injury are discussed in Section 41-28, Laparoscopy. In addition, low transverse abdominal incisions that extend beyond the lateral margins of the rectus muscles can lead to vessel laceration with severe hemorrhage or anterior abdominal wall hematoma formation. These vessels should be identified and ligated when performing a Maylard incision (see Section 41-4, Maylard Incision). Hesselbach triangle is the region in the anterior abdominal wall bounded inferiorly by the inguinal ligament, medially by the lateral border of the rectus muscles, and laterally by the inferior epigastric vessels (see Fig. 38-3). Direct hernias protrude through the abdominal wall in Hesselbach triangle, as opposed to indirect hernias that do so through the deep ring lying lateral to this triangle.
Posted on: Mon, 02 Dec 2013 20:52:26 +0000
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