Clinical anatomy of the inferior epigastric artery with special relevance to invasive procedures of the anterior abdominal wall

Abstract

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.

Guidelines on the management of ascites in cirrhosis

“…In 52 patients (15% obese) with ascites due to cirrhosis, ultrasound demonstrated that the left lower quadrant abdominal wall was thinner and depth of ascites greater, therefore, a suitable site for drain insertion. 147 To minimise the risk of injury to the inferior epigastric artery (and avoid the liver and spleen) during paracentesis, point of puncture should be at least 8 cm from the midline and 5 cm above the symphysis [148][149][150] (figure 4). All ascitic fluid should be drained to dryness in a single session as rapidly as possible over 1-4 hours assisted by gentle mobilisation of the cannula or turning the patient onto their side, if necessary.…”

Inferior epigastric artery injury after percutaneous imaging-guided peritoneal dialysis catheter placement

“…We speculate that one of the IEA branches was lacerated by the inserted PD catheter. This speculation is based on the observations that IEA is approximately 4.5 cm from the midline at the umbilicus level and has on average 3.3 branches arising from its lateral aspect [9] . In addition, our patient had advanced CKD that is usually associated with platelet dysfunction and subsequent increased risk for bleeding [10] .…”

Pedicled Peritoneal Flap Vaginoplasty in Male-to-Female Gender Affirmation Surgery: A Case Report

“…Indocyanine green angiography was used to demonstrate the flap perfusion intraoperatively. 8 , 9 The study was exempted from review by the institutional review board of Chulalongkorn University, and informed consent was obtained from the patient.…”