Anterior Abdominal Wall: Below Umbilicus

Question 1

Below umbilicus

Answer 1

External iliac artery branches:
1. Inferior epigastric artery
2. Deep circumflex iliac artery
Femoral artery superficial branches:
1. Superficial epigastric artery
2. Superficial circumflex iliac artery

Question 2

Inferior epigastric artery: origin

Answer 2

External iliac artery just behind Inguinal ligament

Question 3

Inferior epigastric artery: course and termination

Answer 3

1. Passes upwards and medial to deep Inguinal ring
2. Pierces fascia transversalis
3. Passes in front of arcuate line to enter rectus sheath behind rectus abdominis
4. Terminates at umbilicus level by anastomosing with superior epigastric artery

Question 4

Inferior epigastric artery: branches

Answer 4

1. Cremastric artery
2. Pubic branch

Question 5

Cremasteric artery

Answer 5

Enters deep Inguinal ring to pass as one of spermatic cord contents supplying Cremasteric muscle and ends by anastomosing with testicular artery

Question 6

Pubic branch

Answer 6

1. Descends behind lacunar ligament and superior pubic ramus to anastomose with Obturator artery pubic branch
2. In 30% of cases, obtrurator artery is absent and replaced by abnormal Obturator artery (inferior epigastric artery large pubic branch)

Question 7

Applied anatomy: inferior epigastric artery

Answer 7

1. Important landmark during hernia operation
2. It is medial to sac neck of oblique Inguinal hernia but lateral to that of direct Inguinal hernia

Question 8

Applied anatomy: abnormal obturator artery

Answer 8

1. Passes just behind lacunar ligament free sharp border
2. Liable for injury during femoral hernia operation

Question 9

Deep circumflex artery: origin

Answer 9

External iliac artery just behind Inguinal ligament

Question 10

Deep circumflex artery: course

Answer 10

1. Passes upwards and lateral behind Inguinal ligament reaching ASIS
2. Runs on iliac crest inner lip
3. Pierces transversus abdominis
4. Runs in neurovascular plane

Question 11

Deep circumflex artery: branches

Answer 11

1. Muscular branches: to anterior abdominal wall muscles
2. Anastomotic branches: sharing in anastomosis around ASIS
3. Ascending branch: ascends to anastomose with lumbar and Musculophrenic arteries