The security distance for safe trocar placement was 6 cm at the level of ASIS and 9 cm at the level of umbilicus. Preoperative IEA assessment is helpful in reducing injuries to IEA.

Here we describe a case of double suprascapular foramen formed by the ossification of bifid superior transverse scapular ligament (STSL). During an osteological study of scapula done in the Department of Anatomy, All India Institute of Medical Sciences, Raipur in 2014, we found a left sided scapula with double suprascapular foramen. The measurements of the ossified ligaments and the foramen were done using a digital vernier caliper (Mitutoyo Company, Tokyo, Japan). The length of the suprascapular notch was 11.68mm and the breadth was 7.92mm. There were two bony bars bridging the suprascapular notch [Table/ Fig-1,2]. The superior bony bar was 11.06 mm long. The width of the superior bar was 3.47mm in the medial end, 2.11mm in the middle and 2.49mm in the lateral end. The inferior bony bar was 6.02mm in length. The width of the inferior bar was 3.81mm in the medial end, 3.59mm in the middle, 3.89mm in the lateral end. The superior foramen was triangular in shape with a length of 3.27mm and breadth of 5.78mm. The inferior foramen was oval shaped with a length of 2.99mm and a breadth of 1.34mm. The two bony bars had a common attachment on the lateral border and were attached one below the other on the medial border of the suprascapular notch. Ossified bifid superior transverse scapular ligament causing a double suprascapular foramen is a very rare finding. This ossified ligament reduces the suprascapular space by half of its original size. It is one of the precipitating factors of suprascapular nerve entrapment. Here we describe a double suprascapular foramen in a dry left scapula of Indian origin. There were two bony bars bridging the suprascapular notch thereby making two foramina. The bony bars were 'V' shaped with its apex attached to the lateral side of the suprascapular notch. The upper foramen was large and triangular whereas the lower foramen was small and oval. Considering the shape of the foramen and the 'V' shaped attachment of the bony bars, we conclude it to be due to the ossification of bifid superior transverse scapular ligament. A double suprascapular foramen should always be kept in mind while diagnosing and treating suprascapular nerve entrapment. Knowledge about the double suprascapular foramen would be useful to orthopaedic surgeons who perform decompression for suprascapular nerve entrapment through arthroscopy and open procedures. DisCussionThe suprascapular notch is bridged by the STSL on the superior border of the scapula. The suprascapular nerve goes below the ligament in the notch and the suprascapular vessels pass above the ligament

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INTRODUCTION:Injury to the inferior epigastric artery (IEA) has been reported following lower abdominal wall surgical incisions, abdominal peritoneocentesis and trocar placements at laparoscopic port sites, resulting in the formation of abdominal wall haematomas that may expand considerably due to lack of tissue resistance. The aim of this study was to localise its course in relation to standard anatomic landmarks and suggest safe areas for performance of invasive procedures.MATERIALS AND METHODS:Sixty IEAs of 30 adult cadavers (male = 19; female = 11) were dissected and the course of the IEA noted in relation to the mid-inguinal point, anterior superior iliac spine (ASIS) and umbilicus.RESULTS:The mean distance of the IEA from the midline was 4.45 ± 1.42 cm at the level of the mid-inguinal point, 4.10 ± 1.15 cm at the level of ASIS and 4.49 ± 1.15 cm at the level of umbilicus. There was an average of 3.3 branches per IEA with more branches arising from its lateral aspect. The IEA was situated within one-third (32%) of the distance between the midline and the sagittal plane through ASIS at all levels.CONCLUSION:To avoid injury to IEA, trocars can be safely inserted 5.5 cm [mean + 1 standard deviation (SD)] away from the midline (or) slightly more than one-third of the distance between the midline and a sagittal plane running through ASIS. These findings may be useful not only for laparoscopic procedures but also for image-guided biopsy, abdominal paracentesis, and placement of abdominal drains.