Abdominal wall & Retroperitoneum & Urogenital

Question 1

Describe the borders of lumbar hernias.

Answer 1

Inferior lumbar hernia of petit:
Lateral = EO
Inferior = Iliac crest
Medial = Lat dorsi

Superior lumbar hernia:
Lateral = IO
Medial= Quadratus lumborum
Superior = 12th rib

Question 2

What is the pathogenesis of fascial dehisence?

Answer 2

The abdominal wall pressure overcomes the tissue, suture or knot integrity.

Question 3

What is Hesselbach’s triangle?

Answer 3

An area of relative weakness in anterior abdominal wall where direct inguinal hernias arise. It is bordered medially by linea semilunaris, superiolaterally by inferior epigastric vessels and inferiorly by inguinal ligament.

Question 4

What makes up the femoral triangle?

Question 5

Where do femoral hernias pass through?

Question 6

In a TEP repair what are the triangles of pain and triangles of doom and what are their contents?

Answer 6

Triangle of pain is lateral and bordered by superiorly by iliopubic tract, medially by spermatic vessels and laterally by peritoneal reflection. It contains
- Femoral nerve
- Femoral branch of genitofemoral nerve
- Lateral femoral cutaneous nerve of the thigh
- Anterior femoral cutaneous nerve of the thigh

Triangle of doom is bordered by the vas deferens medially, spermatic vessels laterally and the peritoneal reflection inferiorly. It contains the external iliac vessels and the genital branch of genitofemoral nerve.

Question 7

What is the corona mortis and its relevance surgically?

Answer 7

common variant arterial anastomosis between either the external iliac artery or deep inferior epigastric artery and the obturator artery. Occurs in up to 33% of population.

Its relevant in pelvic pubic rami trauma as a cause of significant bleeding also relevant in TEP hernia repairs .